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.