Stent-Related Adverse Events as Related to Dual Antiplatelet Therapy in First- vs Second-Generation Drug-Eluting Stents

• Published in: JACC. Asia Vol. 1; no. 3; pp. 345 - 356
• Main Authors: Yoshikawa, Yusuke, Shiomi, Hiroki, Morimoto, Takeshi, Takeji, Yasuaki, Matsumura-Nakano, Yukiko, Yamamoto, Ko, Yamamoto, Erika, Kato, Eri T., Watanabe, Hirotoshi, Saito, Naritatsu, Domei, Takenori, Tada, Takeshi, Nawada, Ryuzo, Onodera, Tomoya, Suwa, Satoru, Tamura, Toshihiro, Ishii, Katsuhisa, Ando, Kenji, Furukawa, Yutaka, Kadota, Kazushige, Nakagawa, Yoshihisa, Kimura, Takeshi
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2021
• Subjects: Cardiovascular; drug-eluting stent; dual antiplatelet therapy; stent thrombosis; SES; ST; drug-eluting stent; BMS; ZES; G1; G2; dual antiplatelet therapy; ACS; TVR; ARC; EES; DES; ARC-HBR; stent thrombosis; PCI; CABG; DAPT; PES; everolimus-eluting stent(s); sirolimus-eluting stent(s); zotarolimus-eluting stent(s); drug-eluting stent(s); percutaneous coronary intervention; acute coronary syndrome; target vessel revascularization; Academic Research Consortium High Bleeding Risk; coronary artery bypass grafting; bare-metal stent; Academic Research Consortium; second-generation; first-generation; paclitaxel-eluting stent(s); PCI, percutaneous coronary intervention; SES, sirolimus-eluting stent(s); ARC-HBR, Academic Research Consortium High Bleeding Risk; ARC, Academic Research Consortium; G1, first-generation; DAPT, dual antiplatelet therapy; ZES, zotarolimus-eluting stent(s); ACS, acute coronary syndrome; PES, paclitaxel-eluting stent(s); TVR, target vessel revascularization; CABG, coronary artery bypass grafting; ST, stent thrombosis; BMS, bare-metal stent; DES, drug-eluting stent(s); G2, second-generation; EES, everolimus-eluting stent(s)
• ISSN: 2772-3747; 2772-3747
• DOI: 10.1016/j.jacasi.2021.08.010

There are limited data on the long-term stent-related adverse events as related to the duration of dual antiplatelet therapy (DAPT) in second-generation (G2) drug-eluting stents (DES) compared with first-generation (G1) DES. This study sought to compare the long-term stent-related outcomes of G2-DES with those of G1-DES. The study group consisted of 15,009 patients who underwent their first coronary revascularization with DES from the CREDO-Kyoto PCI/CABG (Coronary Revascularization Demonstrating Outcome Study in Kyoto Percutaneous Coronary Intervention/Coronary Artery Bypass Grafting) Registry Cohort-2 (first-generation drug-eluting stent [G1-DES] period; n = 5,382) and Cohort-3 (second-generation drug eluting stent [G2-DES] period; n = 9,627). The primary outcome measures were definite stent thrombosis (ST) and target vessel revascularization (TVR). The cumulative 5-year incidences of definite ST and TVR were significantly lower in the G2-DES group than in the G1-DES group (0.7% vs 1.4%; P < 0.001; and 16.2% vs 22.1%; P < 0.001, respectively). The lower adjusted risk of G2-DES relative to G1-DES for definite ST and TVR remained significant (HR: 0.53; 95% CI: 0.37-0.76; P < 0.001; and HR: 0.74; 95% CI: 0.68-0.81; P < 0.001, respectively). In the landmark analysis that was based on the DAPT status at 1 year, the lower adjusted risk of on-DAPT status relative to off-DAPT was significant for definite ST beyond 1 year in the G1-DES stratum (HR: 0.42; 95% CI: 0.24-0.76; P = 0.004) but not in the G2-DES stratum (HR: 0.66; 95% CI: 0.26-1.68; P = 0.38) (Pinteraction = 0.14). G2-DES compared with G1-DES were associated with a significantly lower risk for stent-related adverse events, including definite ST and TVR. DAPT beyond 1 year was associated with a significantly lower risk for very late ST of G1-DES but not for that of G2-DES. [Display omitted]