Original title: New-generation drug-eluting stents reduce stent thrombosis and myocardial infarction: a propensity-score-adjusted analysis from the multicenter REAL registry. Reference: Vignali L et al. Cath Cardiovasc Interv. 2014; Epub ahead of print.
Compared to the first generation of drug eluting stents (DES), the new generation has a lower long term risk of in-stent thrombosis and acute myocardial infarction (AMI).
This study analyzed data from 2775 patients receiving first generation DES and 2557 receiving new generation DES included in the REAL registry (multicenter registry in the north of Italy) between 2007 and 2011.
At 3 years, new generation DES were associated to lower AMI and definite thrombosis rates comparted to the first DES, though the combined events rate (death, infarction and revascularization) were no different between the groups.
After propensity score matching, 3 year death rates turned out similar (new generation 7% vs. first generation 8.7%, HR 0.85, IC 0.68 to 1.06) as well as infarction rate (new generation 5% vs. first generation 7.4%, HR 0.65, IC 0.5 to 0.82) and revascularization (10.9% vs. 13.5% respectively, HR 0.99, IC 0.84 to 1.16). The only significant difference was seen in definite thrombosis rates (new generation 0.5% vs. first generation 1.1%, HR 0.35, IC 0.17 to 0.72).
Conclusion
This multicenter registry included data from real life patients confirming that new generation DES compared to first generation DES are associated with similar efficacy but a greater long term safety, due to the lower in-stent thrombosis and AMI rates.
Editorial Comment
Several randomized studies and meta-analysis had shown that newer DES has a better safety profile; however, the present study is one of the largest registries, with the longest follow up period, which confirmed these outcomes in the daily practice.
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