Comparison of Contemporary Drug-Eluting Stents in Patients Undergoing Complex High-Risk Indicated Procedures

• Published in: JACC. Asia 2022-04, Vol.2 (2), p.182-193
• Main Authors: Jeong, Yeong Jin, Hyun, Junho, Lee, Junghoon, Kim, Ju Hyeon, Yang, Yujin, Choe, Kyungjin, Lee, Ji Sung, Park, Hanbit, Cho, Sang-Cheol, Kang, Do-Yoon, Lee, Pil Hyung, Ahn, Jung-Min, Park, Duk-Woo, Park, Seung-Jung
• Format: Article
• Language: English
• Subjects: coronary artery disease; drug-eluting stent; percutaneous coronary intervention
• ISSN: 2772-3747; 2772-3747
• DOI: 10.1016/j.jacasi.2021.10.008

Limited data are available on the relative performances of diverse contemporary drug-eluting stents (DES) in patients undergoing complex high-risk indicated procedures (CHIP). The purpose of this study was to evaluate the comparative effectiveness of contemporary second-generation DES for CHIP patients in “real-world” settings. Of 28,843 patients enrolled in the IRIS-DES registry, a total of 6,645 patients with CHIP characteristics who received 5 different types of contemporary DES were finally included: 3,752 with cobalt-chromium everolimus-eluting stents (CoCr-EES), 1,258 with Resolute zotarolimus-eluting stents (Re-ZES), 864 with platinum-chromium EES (PtCr-EES), 437 with ultrathin strut biodegradable-polymer sirolimus-eluting stents (UT-SES), and 334 with bioresorbable polymer SES (BP-SES). The primary outcome was target-vessel failure (a composite of cardiac death, target-vessel myocardial infarction, and target-vessel revascularization) at 12 months. At 12 months, the rate of target-vessel failure was highest in the CoCr-EES (7.1%) group; intermediate in the Re-ZES (5.0%), PtCr-EES (4.6%), and BP-SES (4.2%) groups; and lowest in the UT-SES (3.8%) group (overall long-rank P = 0.001). In multiple-treatment propensity-score analysis, the adjusted hazard ratios (HRs) for target-vessel failure were significantly lower in the Re-ZES (HR: 0.71; 95% confidence interval [CI]: 0.52-0.97), the UT-SES (HR: 0.52; 95% CI: 0.29-0.95), and BP-SES (HR: 0.33; 95% CI: 0.16-0.70) groups than in the CoCr-EES group (referent). In this contemporary PCI registry, we observed the differential risks of target-vessel failure according to various types of contemporary DES in patients with CHIP characteristics. However, owing to inherent selection bias, the results should be considered hypothesis-generating, highlighting the need for further randomized trials. (Evaluation of the First, Second, and New Drug-Eluting Stents in Routine Clinical Practice [IRIS-DES]; NCT01186133) [Display omitted]