Late differences in outcomes of patients with stable angina and an isolated lesion in the proximal left anterior descending artery treated with new-generation drug-eluting stents

• Published in: International journal of cardiology Vol. 183; pp. 27 - 32
• Main Authors: Toutouzas, Konstantinos, Anousakis-Vlachochristou, Nikolaos, Patsa, Chrysoula, Matsoukis, Ioannis L, Drakopoulou, Maria, Tsiamis, Eleftherios, Latsios, George, Synetos, Andreas, Komatanou, Evmorfia, Spanos, Anastasios, Petridou, Eleni Th, Tousoulis, Dimitris
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ireland Ltd 15.03.2015
• Subjects: Aged; Angina, Stable - diagnosis; Cardiovascular; Chronic stable angina; Coronary Artery Disease - surgery; Drug-eluting stent; Drug-Eluting Stents; Everolimus - therapeutic use; Female; Humans; Immunosuppressive Agents - therapeutic use; Male; Middle Aged; Prospective Studies; Proximal left anterior descending artery; Sirolimus - analogs & derivatives; Sirolimus - therapeutic use; coronary artery disease; Chronic stable angina; everolimus-eluting stent; myocardial infarction; Drug-eluting stent; Target Lesion Revascularization; estimated Glomerular Filtration Rate; Patient-Related Outcome; pLAD; PRO; Endeavor zotarolimus-eluting stent; Chronic Kidney Disease Epidemiology Collaboration study equation; TLF; percutaneous coronary intervention; stent thrombosis; Proximal left anterior descending artery; TLR; ACC/AHA; MI; CKD-EPI; eGFR; proximal segment of left anterior descending artery; ST; E-ZES; coronary artery by-pass grafting; drug-eluting stents; CAD; American Cardiology College/American Heart Association; Academic Research Consortium; MDRD; Modification of Diet in Renal Disease study equation; EES; ARC; DES; PCI; Target Lesion Failure; CABG
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2015.01.044

Abstract Background New-generation drug-eluting stents have demonstrated the mid-term efficacy and safety, but possible differences between stents may emerge in a long-term period. We compared long-term outcomes of patients with chronic stable angina and an isolated de-novo lesion in the proximal left anterior descending artery that underwent percutaneous coronary intervention with Endeavor-zotarolimus eluting stents (E-ZES) and everolimus eluting stents (EES). Methods We prospectively enrolled 600 patients. Of these, 180 underwent E-ZES and 420 underwent EES implantation. Clinical follow-up was performed up to 7 years (median follow-up 61 months). The evaluated clinical outcomes were Target Lesion Failure (TLF), a composite of cardiac death, myocardial infarction and Target Lesion Revascularization (TLR), the Patient-Related Outcome (PRO) and stent thrombosis. Differences between groups evaluated with the Kaplan–Meier method and possible independent predictors with Cox proportional hazard regression. Results At 5 years, the cumulative probability for outcomes was: TLF: 13.8% versus 7.5%, p = 0.025, cardiac death: 3.1% versus 2.5%, p = 0.937, myocardial infarction: 1.2% versus 1.8%, p = 0.829, TLR: 10% versus 3.3%, p = 0.003, PRO: 19.6% versus 13.8%, p = 0.528, ST: 2.5% versus 2.7%, p = 0.965, for E-ZES and EES respectively. Differences between stents increased after 30 months. In multivariate analysis predictors of TLF adjusted for stent type were Diabetes mellitus and estimated Glomerular Filtration Rate (eGFR). Conclusion Both stents provided a favorable safety profile, with EES demonstrating better effectiveness. There was a late emergence in difference of endpoints after 30 months. Diabetes mellitus and eGFR predicted TLF.