Clinical outcomes in low risk coronary artery disease patients treated with different limus-based drug-eluting stents--a nationwide retrospective cohort study using insurance claims database.

Chao-Lun Lai,Ming-Fong Chen,K Arnold Chan,Raymond Nien-Chen Kuo,Yen-Yun Yang,Ching-Fen Wu,Mei-Shu Lai,Ho-Chang Kuo

doi:10.1371/journal.pone.0122860

Abstract

The clinical outcomes of different limus-based drug-eluting stents (DES) in a real-world setting have not been well defined. The aim of this study was to investigate the clinical outcomes of three different limus-based DES, namely sirolimus-eluting stent (SES), Endeavor zotarolimus-eluting stent (E-ZES) and everolimus-eluting stent (EES), using a national insurance claims database. We identified all patients who received implantation of single SES, E-ZES or EES between January 1, 2007 and December 31, 2009 from the National Health Insurance claims database, Taiwan. Follow-up was through December 31, 2011 for all selected clinical outcomes. The primary end-point was all-cause mortality. Secondary end-points included acute coronary events, heart failure needing hospitalization, and cerebrovascular disease. Cox regression model adjusting for baseline characteristics was used to compare the relative risks of different outcomes among the three different limus-based DES. Totally, 6584 patients were evaluated (n=2142 for SES, n=3445 for E-ZES, and n=997 for EES). After adjusting for baseline characteristics, we found no statistically significant difference in the risk of all-cause mortality in three DES groups (adjusted hazard ratio [HR]: 1.14, 95% confidence interval [CI]: 0.94-1.38, p=0.20 in E-ZES group compared with SES group; adjusted HR: 0.77, 95% CI: 0.54-1.10, p=0.15 in EES group compared with SES group). Similarly, we found no difference in the three stent groups in risks of acute coronary events, heart failure needing hospitalization, and cerebrovascular disease. In conclusion, we observed no difference in all-cause mortality, acute coronary events, heart failure needing hospitalization, and cerebrovascular disease in patients treated with SES, E-ZES, and EES in a real-world population-based setting in Taiwan.

Highlights

Since the advent of percutaneous intervention, the goal of coronary interventional treatment has been maximizing both the safety and efficacy of coronary revascularization
After adjusting for baseline characteristics, we found no statistically significant difference in the risk of all-cause mortality in three drug-eluting stents (DES) groups
As for the medications prescribed at discharge, patients in the everolimus-eluting stent (EES) group were more likely to have prescriptions of statins, and patients in the Endeavor zotarolimus-eluting stent (E-ZES) group were more likely to have been prescribed with aspirin

Summary

Introduction

Since the advent of percutaneous intervention, the goal of coronary interventional treatment has been maximizing both the safety and efficacy of coronary revascularization. Stent implantation has offered an effective method of treating coronary heart disease.[1,2] The introduction of the first-generation drug-eluting stents (DES), i.e. sirolimus-eluting stent (SES) and paclitaxel-eluting stent (PES), markedly reduced the need for repeated intervention compared with angioplasty alone or the use of bare-metal stents.[3,4,5,6] Notwithstanding, the effective inhibition of in-stent neointimal formation by the first-generation DES may delay re-endothelialization, leave stent struts as the nidus for late stent thrombosis and give rise to safety concern.[6,7,8,9] For the first-generation DES, SES is superior to PES in terms of a significant reduction of the risk of re-intervention and stent thrombosis.[3,10].

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