Comparison of First- and Second-Generation Drug-Eluting Stents in Patients with Acute Myocardial Infarction and Prediabetes Based on the Hemoglobin A1c Level.

Yong Hoon Kim ,Yangsoo Jang,Donghoon Choi,Seunghwan Kim,Byeong‐Keuk Kim ,Myung Ho Jeong ,Myeong Ki Hong ,Young Guk Ko ,Ae Young Her ,Jung Sun Kim ,Sung Jin Hong ,Chul‐Min Ahn

doi:10.1155/2020/1710439

Abstract

Objective To compare major clinical outcomes after successful percutaneous coronary intervention (PCI) with first-generation (1G) drug-eluting stents (DES) and second-generation (2G) DES in patients with acute myocardial infarction (AMI) and prediabetes. Background Patients with prediabetes are associated with an increased incidence of coronary artery disease. The relative superiority of 1G- and 2G-DES in these patients is not well established. Methods A total of 4997 patients with AMI and prediabetes were divided into two groups: the 1D-DES group (n = 726) and the 2G-DES group (n = 4271). The primary outcomes were the patient-oriented composite outcomes (POCOs) defined as all-cause death, recurrent myocardial infarction (Re-MI), and any disease revascularization at 2-year follow-up. The secondary outcome was probable or definite stent thrombosis (ST). Results After propensity score-matching (PSM) analysis, two PSM groups (698 pairs, n = 1396, C-statistics = 0.725) were generated. The cumulative incidence rates of POCOs (hazard ratio (HR): 1.467; 95% confidence interval (CI): 1.068–2.015; p = 0.018), any disease revascularization (HR: 2.259; 95% CI: 1.397–3.654; p = 0.001), and ST (HR: 4.361; 95% CI: 1.243–15.30; p = 0.021) in the 1G-DES group were significantly higher than those in the 2G-DES group. However, the cumulative incidence rates of all-cause death, cardiac death, and Re-MI were similar between the two groups. Conclusions In patients with AMI and prediabetes, 2G-DES implantation was more efficacious than 1G-DES implantation over a 2-year follow-up period. However, further studies are needed to confirm these results.

Highlights

In the fibrinolytic era, hyperglycemia, rather than normoglycemia, was a major independent prognostic factor of adverse clinical outcomes in patients with acute myocardial infarction (AMI) [1, 2]
Patients with prediabetes are at an increased risk of cardiovascular disease (CVD), and prediabetes is associated with an increased incidence of coronary artery disease (CAD) [8, 9]
We evaluated patients who had provided written informed consent prior to participation in the Korea AMI Registry (KAMIR) study. erefore, any information concerning adverse events of these 4997 participants with AMI and prediabetes including the time intervals and the types of events after the index percutaneous coronary intervention (PCI), which occurred during a 2-year follow-up period, was monitored at the outpatient clinic, by phone calls, or by reviewing their charts at each participating center in those days

Summary

Objective

To compare major clinical outcomes after successful percutaneous coronary intervention (PCI) with first-generation (1G) drug-eluting stents (DES) and second-generation (2G) DES in patients with acute myocardial infarction (AMI) and prediabetes. Patients with prediabetes are associated with an increased incidence of coronary artery disease. E primary outcomes were the patient-oriented composite outcomes (POCOs) defined as all-cause death, recurrent myocardial infarction (Re-MI), and any disease revascularization at 2-year follow-up. E cumulative incidence rates of POCOs (hazard ratio (HR): 1.467; 95% confidence interval (CI): 1.068–2.015; p 0.018), any disease revascularization (HR: 2.259; 95% CI: 1.397–3.654; p 0.001), and ST (HR: 4.361; 95% CI: 1.243–15.30; p 0.021) in the 1G-DES group were significantly higher than those in the 2G-DES group. In patients with AMI and prediabetes, 2G-DES implantation was more efficacious than 1G-DES implantation over a 2-year follow-up period.

Introduction

Methods

Results