Korean J Med.  2015 Aug;89(2):192-200. 10.3904/kjm.2015.89.2.192.

Comparison of Clinical Outcomes after Implantation of First- and Second-Generation Overlapping Drug-Eluting Stents to Treat Diffuse Long Coronary Lesions

• Oh KS
• Jeong MH
• Rhee JA
• Choi JS
• Lee DH
• Kim JH
• Park SH
• Kim IS
• Hyun DY
• Jeong YA
• Jeong HC
• Park KH
• Sim DS
• Yoon HJ
• Kim KH
• Park HU
• Hong YJ
• Ahn Y
• Cho JG
• Park JC

• KMID: 2269028
• DOI: http://doi.org/10.3904/kjm.2015.89.2.192

Abstract

BACKGROUND/AIMS
Despite improved revascularization techniques, the clinical outcomes of patients with diffuse coronary artery lesions after percutaneous coronary intervention are unsatisfactory. However, few studies have compared the efficacy of first- and second-generation drug-eluting stents (DES) in patients with diffuse long coronary artery lesions.
METHODS
Between January 2006 and July 2012, 364 patients who were treated with DES for long coronary artery stenosis (> 30 mm) were enrolled in this study and assigned to either Group I (first-generation DES, 62.3 +/- 10.4 years, 136 males, n = 183) or Group II (second-generation DES, 64.3 +/- 10.7 years, 134 males, n = 181). The incidence of major adverse cardiac events (MACE) was compared between the two groups over 2 years of follow-up, and predictive factors associated with MACE were evaluated through a multivariate analysis.
RESULTS
Although several coronary angiographic characteristics were different between the two groups, most demographic and baseline clinical variables were the same. The cumulative incidence of MACE was significantly higher in Group I than in Group II (25.7 vs. 6.6%; p < 0.001), mainly due to reduced target lesion revascularization (21.9 vs. 2.2%; p < 0.001). According to the results of the multivariate analysis, the use of a paclitaxel-eluting stent (PES) (hazard ratio [HR], 5.168; 95% confidence interval [CI], 2.515-10.617; p < 0.001), decreased left ventricular function (< or = 45%; HR, 3.586; 95% CI, 1.839-6.990; p < 0.001), and diabetes mellitus (HR, 2.984; 95% CI, 1.605-5.548; p < 0.001) were independent contributors to MACE.
CONCLUSIONS
For patients with diffuse long coronary artery stenosis, the use of second-generation DES improved the clinical outcome compared with first-generation DES. In addition, the use of a PES, left ventricular dysfunction, and diabetes were predictors of MACE after overlapping stenting.

Keyword

Drug-eluting stents; Percutaneous coronary intervention

MeSH Terms

Coronary Stenosis
Coronary Vessels
Diabetes Mellitus
Drug-Eluting Stents*
Follow-Up Studies
Humans
Incidence
Male
Multivariate Analysis
Percutaneous Coronary Intervention
Stents
Ventricular Dysfunction, Left
Ventricular Function, Left