Comparison of second- and first-generation drug eluting stent for percutaneous coronary chronic total occlusion intervention

• We compared the outcomes after CTO–PCI using first and second generation DESs.
• The incidence of MACE was comparable between two groups at 3 years of follow-up.
• The generation of DES was not an independent predictor of future MACE.
• The incidence of definite/probable stent thrombosis was low for both groups.

BackgroundThe performance of contemporary second-generation drug-eluting stents (DESs) for percutaneous chronic total occlusion (CTO) intervention is not well established. The present study compared the efficacy and safety outcomes of second-generation DESs with those of first-generation DESs in CTO-percutaneous coronary intervention (PCI).MethodsThis retrospective analysis included 1049 consecutive CTO patients who underwent successful DES implantation (first-generation; 487 vs. second-generation; 562 patients) between March 2003 and August 2014. The primary endpoint was the composite of all-cause death, Q-wave myocardial infarction (MI), or target-vessel revascularization (TVR).ResultsDuring a follow-up of 3 years, the primary endpoint incidence was 10.1% for second- and 7.7% for first-generation DES (p = 0.30). After multivariable adjustment, there was no significant difference between these groups in terms of the risk of composite of death, Q-wave MI, or TVR (Hazard ratio [HR] 1.42, 95% confidence interval [CI] 0.88–2.28, p = 0.15) nor in the individual risks of death (adjusted HR 1.33, 95% CI 0.69–2.56, p = 0.39), Q-wave MI (adjusted HR 1.15, 95% CI 0.30–4.47, p = 0.84) and TVR (adjusted HR 1.06, 95% CI 0.52–2.15, p = 0.87). The incidence of definite/probable stent thrombosis was relatively low (0.5% vs.0.9%, p = 0.17) throughout the follow-up period.ConclusionThe 3-year clinical outcomes of patients treated with second-generation DESs are comparable to those treated with first-generation DESs for CTO–PCI.