Purpose: There are few clinical outcome data comparing first-versus second-generation drug-eluting stents (DESs) in patients with multivessel coronary artery disease (MVD) who underwent successful percutaneous coronary intervention (PCI).
Methods: From January 2004 to May 2011, a total of 642 MVD patients were enrolled. Patients were excluded if they had: (1) bare-metal stent or other types of DESs (e.g., third generation DESs or Bioabsorbable vascular scaffold) implantation, (2) plain balloon angioplasty, (3) incomplete or invalid data. Finally, a total of 625 eligible MVD patients who underwent PCI with first-generation DESs (Paclitaxel- or Sirolimus-eluting stent, n = 350) or second-generation DESs (Zotarolimus- or Everolimus-eluting stent, n = 275) were enrolled. To adjust for any potential confounders, a propensity score matched (PSM) analysis was performed using the logistic regression model and 2 propensity-matched groups (205 pairs, n = 410, C-statistic = 0.746) were generated. Cumulative major adverse cardiac events (MACEs) up to 3 years were compared between the first- and second-generation DES group. MACE was defined as total death, non-fatal myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), and non-target vessel revascularization (Non-TVR).
Results: During the 3-year follow-up period, the cumulative incidence of total death (hazard ration [HR], 9.18; 95% confidence interval [CI], 1.16-72.5; p = 0.035) and TVR-MACEs (HR, 1.80; 95% CI, 1.01-3.23; p = 0.046) were significantly higher in the first-generation DESs group compared with the second-generation group after PSM (Table and Figure).
Conclusions: During 3-year follow-up periods, first-generation DESs was associated with higher incidence of total death and TVR-MACEs in MVD patients who underwent successful PCI. However, the incidence of MI and revascularization were similar between the two groups.