The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Catheter Cardiovasc Interv. 2021 Jun 1;97(7):1341-1351. doi: 10.1002/ccd.28996. Epub 2020 Jun 1.
We aimed to evaluate the 1-year outcomes of three everolimus-eluting stents (EES) for complex percutaneous coronary intervention (PCI).
It is controversial whether contemporary bioresorbable-polymer drug-eluting stents (BP-DES) are associated with better outcomes compared with durable-polymer DES (DP-DES).
Patients undergoing PCI with cobalt-chromium (CoCr)-DP-EES (Xience), platinum-chromium (PtCr)-DP-EES (Promus), or PtCr-BP-EES (Synergy) at one high-volume institution between 2015 and 2017 were included. The primary endpoint was 1-year major adverse cardiac events (MACE), a composite of death, myocardial infarction, and target-vessel revascularization. Associations were also examined in patients undergoing complex PCI. Multivariable analysis was conducted to adjust for baseline differences across groups.
We included n = 5,446 patients (CoCr-DP-EES, n = 3,177; PtCr-DP-EES, n = 1,555; PtCr-BP-EES, n = 714). Patients treated with PtCr-BP-EES had higher comorbidity burden and procedural complexity. At 1 year, MACE rates were 8.9% for CoCr-DP-EES versus 8.9% for PtCr-DP-EES versus 8.6% for PtCr-BP-EES (p = .97). The incidence of definite/probable stent thrombosis (ST) was also similar (0.6 vs. 0.4 vs. 0.3%, p = .69). Complex PCI was performed in n = 2,894/5,446 (53.1%). At 1 year, MACE rates were 11.5 versus 10.7 versus 10.3%, respectively (p = .83). The incidence of definite/probable ST was also similar (0.9 vs. 0.3 vs. 0.3%, p = .22). On multivariable analysis, stent type was not an independent predictor of MACE either in the overall or in the complex PCI population.
We observed comparable 1-year rates of MACE and definite/probable ST in patients undergoing PCI with CoCr-DP-EES, PtCr-DP-EES, and PtCr-BP-EES. Results were unchanged among patients undergoing complex PCI. Future multicenter randomized studies should confirm and extend our findings.
我们旨在评估三种依维莫司洗脱支架（EES）在复杂经皮冠状动脉介入治疗（PCI）中的 1 年结果。
目前尚不清楚与持久性聚合物药物洗脱支架（DP-DES）相比，当代生物可吸收聚合物药物洗脱支架（BP-DES）是否具有更好的疗效。
在一家高容量机构，纳入 2015 年至 2017 年间接受钴铬（CoCr）-DP-EES（Xience）、铂铬（PtCr）-DP-EES（Promus）或 PtCr-BP-EES（Synergy）行 PCI 的患者。主要终点是 1 年主要不良心脏事件（MACE），包括死亡、心肌梗死和靶血管血运重建的复合终点。还在接受复杂 PCI 的患者中进行了相关性分析。多变量分析用于调整组间的基线差异。
我们纳入了 n=5446 例患者（CoCr-DP-EES，n=3177；PtCr-DP-EES，n=1555；PtCr-BP-EES，n=714）。接受 PtCr-BP-EES 治疗的患者合并症负担和手术复杂程度更高。1 年后，CoCr-DP-EES、PtCr-DP-EES 和 PtCr-BP-EES 的 MACE 发生率分别为 8.9%、8.9%和 8.6%（p=0.97）。确定/可能的支架血栓形成（ST）发生率也相似（0.6%比 0.4%比 0.3%，p=0.69）。n=2894/5446（53.1%）患者行复杂 PCI。1 年后，MACE 发生率分别为 11.5%、10.7%和 10.3%（p=0.83）。确定/可能的 ST 发生率也相似（0.9%比 0.3%比 0.3%，p=0.22）。多变量分析显示，支架类型在总体人群或复杂 PCI 人群中均不是 MACE 的独立预测因素。
我们观察到接受 CoCr-DP-EES、PtCr-DP-EES 和 PtCr-BP-EES 行 PCI 的患者 1 年时 MACE 和确定/可能 ST 的发生率相似。在接受复杂 PCI 的患者中，结果保持不变。未来的多中心随机研究应证实并扩展我们的发现。
