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Comparison of Efficacy and Safety between First- and Second-Generation Drug-Eluting Stents in Patients with Acute Coronary Syndrome

摘要:

Background: It remains undetermined whether second-generation drug-eluting stents (G2-DESs) outperform first-generation DESs (G1 -DESs) in patients with acute coronary syndrome (ACS). We aimed to compare the efficacy and safety of G1 -DES and G2-DES in ACS patients in a high-volume cardiovascular center. Methods: In 2013,10,724 consecutive patients underwent percutaneous coronary intervention in our institution. We included 4037 patients with ACS who underwent exclusively G1-DES or G2-DES implantation (n = 364 and n = 3673,respectively). We used propensity score matching to minimize the imbalance between the G1-DES and G2-DES groups and followed patients for 2 years. The efficacy endpoints were major adverse cardiac events (MACEs) and its components including target vessel-related myocardial infarction (TV-MI), target vessel revascularization/target lesion revascularization (TVR/TLR), and cardiac death. The safety endpoint was stent thrombosis. Continuous variables were compared by Mann-Whitney U-test, and categorical variables were compared using Pearson's Chi-square or Fisher's exact test. Kaplan-Meier curves were constructed to compare the event-free survival rates,and multivariate Cox proportional hazards regression analysis was used to assess whether stent type was an independent risk factor for the efficacy and safety endpoints. Results: At the 2-year follow-up, the results for MACE and it components, as well as stent thrombosis, were similar for Gl-DES and G2-DES (MACE, 5.2% vs.4.3%,x2 = 0.514,0.474; TV-MI, 0.8% vs.0.4%,P=0.407; TVR, 4.9% vs.3.7%,X2 = 0.939,P=0.333; TLR, 3.8% vs.2.5%,X2= 1.610,P=0.205; cardiac death, 0.3% vs.0.5%, P= 0.670; and stent thrombosis, 0.5% vs.0.4%,P> 0.999). Kaplan-Meier analysis indicated similar event-free survival rates between Gl-DES and G2-DES after propensity score matching (all: log-rankP>0.05). Multivariate analysis demonstrated that stent type was not an independent risk factor for the efficacy and safety endpoints (MACE, hazard ratio [HR] = 0.805, 95% confidence interval [CI]: 0.455-1.424, P = 0.456; TV-MI, HR = 0.500,95% CI: 0.101-2.475, P = 0.395; TVR, HR = 0.732, 95% CI: 0.403-1.330,P = 0.306; TLR, HR = 0.629, 95% CI: 0.313-1.264, P = 0.193; cardiac death, HR = 1.991, 95% CI: 0.223-17.814,P =0.538; and stent thrombosis, HR = 0.746,95% CI: 0.125-4.467, P = 0.749). Conclusion: Gl-DES and G2-DES have similar efficacy and safety profiles in ACS patients at the 2-year follow-up.

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作者单位: Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China [1]
期刊: 《中华医学杂志(英文版)》2018年131卷12期 1397-1405页 SCIMEDLINEISTICCSCDBP
栏目名称: Original Articles
DOI: 10.4103/0366-6999.233959
发布时间: 2018-08-15
基金项目:
This study was supported by the grants from the National Key R&D Program of China sub-project the National Natural Science Foundation of China
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