Improved outcomes after second generation DESs implantation in patients with ACSs: insights from a multicentre, prospective registry

Abstract

Aims: The aim of this study was to evaluate one-year outcomes after implantation of 1st and 2nd generation drug eluting stents (DES) in patients presenting with acute coronary syndrome (ACS). Methods: This is a multicenter registry of 437 patients with ACS, in whom percutaneous coronary intervention (PCI) utilizing DES was performed. One hundred and twenty one sirolimus eluting stents (SES, Cypher), 128 biolimus eluting stenst (BES, Biomatrix), 91 zotarolimus (ZES, Endeavor Resolute) and 97 everolimus (EES, Xience V) were implanted. SES were defined as first (DES1, n=121), while ZES, EES and BES as second generation DES (DES2, n=316). Results: The study groups were comparable with regard to baseline demographic clinical and procedural characteristics, however there were more incidents of STEMI in DES2 group (27,8% vs. 18,1%; p=0,03).There were no differences in mortality and major adverse cardiovascular and cerebrall events (MACCE) in the periprocedural period between the groups. At one-year follow up the incidence of MACCE (15.7 vs. 7.6% p=0.01) and any cause mortality (5 vs. 1.6% p=0.04) were lower in the DES 2 group when compared with DES 1. There was also a trend toward lower cardiac mortality (4.4 vs. 0.8% p=0.05) and the rate of repeated revascularization (10 vs. 5.4% p=0.09) in favor of DES 2 group. The estimated long-term survival, freedom from MACCE and repeated revascularization was higher in the DES 2 group. Implantation of the 2nd generation DES was the only independent factor decreasing the risk of long term MACCE (RR:0.5 95% CI:0,3-0,9). Conclusions: Despite higher clinical risk, implantation of second generation DES was associated with lower rate of adverse events at one year. Further investigations are required to confirm this hypothesis generating registry.