Clinical Outcomes With Use of Second- vs First-Generation DES for PCI

Second-generation (2G) drug-eluting stents (DES) were found to be associated with better clinical outcomes than first-generation (1G) DES, 2 years after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) and comorbid prediabetes, according to a study published in the Journal of Interventional Cardiology.

In this retrospective cohort study, the data of 45,863 adult patients with AMI who underwent successful stent implantation during PCI were pulled from the Korea AMI Registry that includes patients from >50 community and teaching hospitals in South Korea.

Inclusion criteria were the presence of AMI and prediabetes, identified based on medical history, glycated hemoglobin between 5.7% and 6.4%, and fasting plasma glucose between 100 and 125mg/dL at indexed hospitalization.

Patients included in the analysis were categorized based on the type of DES used (1D-DES, n=726; 2G-DES, n=4271). The study’s primary outcomes were patient-oriented composite outcomes (POCOs; ie, all-cause death, recurrent myocardial infarction [Re-MI], and any disease revascularization) 2 years after intervention. Probable or definite stent thrombosis was the secondary outcome.

After propensity score-matching, there were 698 patients in each group. Patients who received 1G- vs 2G-DES had higher cumulative incidence rates of: POCOs (hazard ratio [HR], 1.47; 95% CI, 1.07–2.02; P =.018), any disease revascularization (HR, 2.26; 95% CI, 1.40–3.65; P =.001), and stent thrombosis (HR, 4.36; 95% CI, 1.24–15.30; P =.02). The cumulative incidence rates of all-cause death (HR, 1.15; 95% CI, 0.74–1.79; P =.54), cardiac death (HR, 1.30; 95% CI, 0.78–2.19; P =.32), and Re-MI (HR, 1.02; 95% CI, 0.38–2.71; P =.97) were comparable between the 2 groups.

Significant predictors of POCOs in this cohort included age ≥65 years (HR, 1.32; 95% CI, 1.1–1.6; P =.009), left ventricular ejection fraction <50% (HR, 1.44; 1.19–1.73; P <.001), cardiopulmonary resuscitation on admission (HR, 3.72; 95% CI, 2.80–4.95; P <.001), use of a lipid-lowering agents (HR, 2.36; 95% CI, 1.91–2.86; P <.001), and the presence of multivessel disease (HR, 1.59; 95% CI, 1.30–1.93; P <.001). A significant predictor of any-disease revascularization was multivessel disease (HR, 1.79; 95% CI, 1.33–2.42; P <.001).

Limitations of the study include its retrospective design, the lack of a randomization protocol and of data on patients’ adherence to medications, and the relatively short follow-up period (2 years) for the assessment of long-term major clinical outcomes.

“[T]he results of this study may provide a meaningful message to the interventional cardiologist during PCI to help select the appropriate DES, especially in patients with AMI and prediabetes,” noted the study authors.

Reference

Kim YH, Her AY, Jeong MH, et al. Comparison of first- and second-generation drug-eluting stents in patients with acute myocardial infarction and prediabetes based on the hemoglobin A1c level. J Interv Cardiol. Published July 18, 2020. doi:10.1155/2020/1710439