Stent-Related Adverse Events as Related to Dual Antiplatelet Therapy in First- vs Second-Generation Drug-Eluting Stents

Yusuke Yoshikawa; Hiroki Shiomi; Takeshi Morimoto; Yasuaki Takeji; Yukiko Matsumura-Nakano; Ko Yamamoto; Erika Yamamoto; Eri T Kato; Hirotoshi Watanabe; Naritatsu Saito; Takenori Domei; Takeshi Tada; Ryuzo Nawada; Tomoya Onodera; Satoru Suwa; Toshihiro Tamura; Katsuhisa Ishii; Kenji Ando; Yutaka Furukawa; Kazushige Kadota; Yoshihisa Nakagawa; Takeshi Kimura; CREDO-Kyoto PCI/CABG Registry Cohort-2 and Cohort-3 Investigators

doi:10.1016/j.jacasi.2021.08.010

Stent-Related Adverse Events as Related to Dual Antiplatelet Therapy in First- vs Second-Generation Drug-Eluting Stents

JACC Asia. 2021 Nov 23;1(3):345-356. doi: 10.1016/j.jacasi.2021.08.010. eCollection 2021 Dec.

Authors

Yusuke Yoshikawa¹, Hiroki Shiomi¹, Takeshi Morimoto², Yasuaki Takeji¹, Yukiko Matsumura-Nakano¹, Ko Yamamoto¹, Erika Yamamoto¹, Eri T Kato¹, Hirotoshi Watanabe¹, Naritatsu Saito¹, Takenori Domei³, Takeshi Tada⁴, Ryuzo Nawada⁵, Tomoya Onodera⁵, Satoru Suwa⁶, Toshihiro Tamura⁷, Katsuhisa Ishii⁸, Kenji Ando³, Yutaka Furukawa⁹, Kazushige Kadota⁴, Yoshihisa Nakagawa¹⁰, Takeshi Kimura¹; CREDO-Kyoto PCI/CABG Registry Cohort-2 and Cohort-3 Investigators

Affiliations

¹ Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
² Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan.
³ Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan.
⁴ Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan.
⁵ Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan.
⁶ Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan.
⁷ Department of Cardiology, Tenri Hospital, Tenri, Japan.
⁸ Department of Cardiology, Kansai Electric Power Hospital, Osaka, Japan.
⁹ Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
¹⁰ Department of Cardiovascular Medicine, Shiga University of Medical Science Hospital, Otsu, Japan.

Abstract

Background: There are limited data on the long-term stent-related adverse events as related to the duration of dual antiplatelet therapy (DAPT) in second-generation (G2) drug-eluting stents (DES) compared with first-generation (G1) DES.

Objectives: This study sought to compare the long-term stent-related outcomes of G2-DES with those of G1-DES.

Methods: The study group consisted of 15,009 patients who underwent their first coronary revascularization with DES from the CREDO-Kyoto PCI/CABG (Coronary Revascularization Demonstrating Outcome Study in Kyoto Percutaneous Coronary Intervention/Coronary Artery Bypass Grafting) Registry Cohort-2 (first-generation drug-eluting stent [G1-DES] period; n = 5,382) and Cohort-3 (second-generation drug eluting stent [G2-DES] period; n = 9,627). The primary outcome measures were definite stent thrombosis (ST) and target vessel revascularization (TVR).

Results: The cumulative 5-year incidences of definite ST and TVR were significantly lower in the G2-DES group than in the G1-DES group (0.7% vs 1.4%; P < 0.001; and 16.2% vs 22.1%; P < 0.001, respectively). The lower adjusted risk of G2-DES relative to G1-DES for definite ST and TVR remained significant (HR: 0.53; 95% CI: 0.37-0.76; P < 0.001; and HR: 0.74; 95% CI: 0.68-0.81; P < 0.001, respectively). In the landmark analysis that was based on the DAPT status at 1 year, the lower adjusted risk of on-DAPT status relative to off-DAPT was significant for definite ST beyond 1 year in the G1-DES stratum (HR: 0.42; 95% CI: 0.24-0.76; P = 0.004) but not in the G2-DES stratum (HR: 0.66; 95% CI: 0.26-1.68; P = 0.38) (P _interaction = 0.14).

Conclusions: G2-DES compared with G1-DES were associated with a significantly lower risk for stent-related adverse events, including definite ST and TVR. DAPT beyond 1 year was associated with a significantly lower risk for very late ST of G1-DES but not for that of G2-DES.

Keywords: ACS, acute coronary syndrome; ARC, Academic Research Consortium; ARC-HBR, Academic Research Consortium High Bleeding Risk; BMS, bare-metal stent; CABG, coronary artery bypass grafting; DAPT, dual antiplatelet therapy; DES, drug-eluting stent(s); EES, everolimus-eluting stent(s); G1, first-generation; G2, second-generation; PCI, percutaneous coronary intervention; PES, paclitaxel-eluting stent(s); SES, sirolimus-eluting stent(s); ST, stent thrombosis; TVR, target vessel revascularization; ZES, zotarolimus-eluting stent(s); drug-eluting stent; dual antiplatelet therapy; stent thrombosis.