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Long‐term outcome in patients treated with first‐ versus second‐generation drug‐eluting stents for the treatment of unprotected left main coronary artery stenosis
Author(s) -
Zandvoort Laurens J. C.,
Bommel Rutger J.,
Masdjedi Kaneshka,
Tovar Forero Maria Natalia,
Lemmert Miguel M.,
Wilschut Jeroen,
Diletti Roberto,
Jaegere Peter P. T.,
Zijlstra Felix,
Mieghem Nicolas M.,
Daemen Joost
Publication year - 2020
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28387
Subject(s) - medicine , percutaneous coronary intervention , mace , myocardial infarction , hazard ratio , cardiology , conventional pci , cumulative incidence , clinical endpoint , confidence interval , drug eluting stent , population , target lesion , acute coronary syndrome , revascularization , stent , stenosis , surgery , cohort , clinical trial , environmental health
Abstract Objective and background The study aim is to provide long‐term clinical outcome after percutaneous coronary intervention (PCI) for unprotected left main coronary arteries (ULMCA) stenosis with the first‐generation (1 st ‐gen) drug‐eluting stents (DES) in comparison to 2 nd ‐gen DES, since this is largely unknown. Methods Between May 2002, and December 2014, a consecutive series of 656 all‐comer patients underwent a PCI for ULMCA stenosis at the Erasmus Medical Center. A total of 235 patients were treated with 1 st ‐gen DES, while a total of 421 patients were treated with 2 nd ‐gen DES. Results Overall, the population consisted of 73% males and 58% presented with an acute coronary syndrome. Median follow‐up time was 1,361 days (range from 0 to 5,031). At 5 years, the cumulative incidence of major adverse clinical events (the primary composite endpoint of all‐cause death, any myocardial infarction or target lesion revascularization; MACE) did not differ between 1 st ‐ and 2 nd ‐gen DES (36.8 vs. 38.6%, respectively, Log Rank p = .79, adjusted hazard ratio [HR] = 1.28 [95% confidence interval (CI) 0.94–1.74]). No difference was found in the individual endpoints of all‐cause mortality (29.5 vs. 29% respectively, p = .88, adjusted HR = 1.19 [95% CI, 0.84–1.68]), target vessel myocardial infarction (5.0 vs. 8.4%, p = 0.17, adjusted HR = 1.75 [95% CI, 0.78–3.96]) and target lesion revascularization (8.1 vs. 9.8%, p = .94, adjusted HR = 1.16 [95% CI, 0.59–2.29]) between the 1 st ‐ and 2 nd ‐gen DES cohorts, respectively. Conclusions In this large cohort of consecutive patients treated for ULMCA stenosis, no significant differences were found in the safety and efficacy of 1 st versus 2 nd ‐gen DES at 5 years follow‐up.