New-generation drug-eluting stents reduce stent thrombosis and myocardial infarction: A propensity-score-adjusted analysis from the multicenter REAL registry (REgistro Regionale AngiopLastiche Dell'Emilia-Romagna)

Luigi Vignali, Francesco Saia, Laura Maria Beatrice Belotti, Emilia Solinas, Paolo Guastaroba, Andrea Rubboli, Antonio Manari, Roxana Mehran, Diego Ardissino, Rossana De Palma

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objectives The aim of this study was to compare long-term clinical outcomes in patients treated with new-generation drug-eluting stent (DES) or early-generation DES in a real-world registry. Background New-generation DESs have proved to be more effective and safer than early-generation DES in randomized trials. However, the effects of new-generation DES versus early-generation DES in everyday clinical practice deserve further verification. Methods A propensity-score and inverse-probability weighted analysis of 5,332 patients undergoing DES implantation (2,557 new-generation and 2,775 early-generation) between January 1, 2007 and June 30, 2011 was performed, with a median follow-up of 3 years. We assessed the incidence of major adverse cardiovascular events (MACE: all-cause death, nonfatal myocardial infarction [MI], and target vessel revascularization [TVR]), and angiographic stent thrombosis (ST) during follow-up. Results At 3-years, new-generation DES in comparison with early-generation DES were associated with a reduced risk of MI (5% versus 7.4%, hazard ratio [HR] = 0.65, 95% confidence interval [CI] = 0.51-0.82, P = 0.0004) and angiographic ST (0.5% vs. 1.1%, HR = 0.35, 95% CI 0.17-0.72, P = 0.004), whereas, the risk of TVR (10.9% vs. 13.5%; HR 0.99, 95% CI 0.84-1.16, P = 0.99) and overall MACE was not significantly different (19.2% vs. 22.4%, HR = 0.94, 95% CI = 0.83-1.07, P = 0.35). Conclusions Our data from a large all-comers multicenter registry confirm that, in comparison with early-generation DES, the use of new-generation DES is associated with similar efficacy and increased long-term safety, because of a reduced risk of ST and MI.

Original languageEnglish
Pages (from-to)797-806
Number of pages10
JournalCatheterization and Cardiovascular Interventions
Volume85
Issue number5
DOIs
Publication statusPublished - Apr 1 2015
Externally publishedYes

Fingerprint

Propensity Score
Drug-Eluting Stents
Stents
Registries
Thrombosis
Myocardial Infarction
Confidence Intervals
Cohort Effect
Cause of Death
Safety

Keywords

  • drugs
  • myocardial infarction
  • revascularization
  • stents
  • thrombosis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

New-generation drug-eluting stents reduce stent thrombosis and myocardial infarction : A propensity-score-adjusted analysis from the multicenter REAL registry (REgistro Regionale AngiopLastiche Dell'Emilia-Romagna). / Vignali, Luigi; Saia, Francesco; Belotti, Laura Maria Beatrice; Solinas, Emilia; Guastaroba, Paolo; Rubboli, Andrea; Manari, Antonio; Mehran, Roxana; Ardissino, Diego; De Palma, Rossana.

In: Catheterization and Cardiovascular Interventions, Vol. 85, No. 5, 01.04.2015, p. 797-806.

Research output: Contribution to journalArticle

Vignali, Luigi ; Saia, Francesco ; Belotti, Laura Maria Beatrice ; Solinas, Emilia ; Guastaroba, Paolo ; Rubboli, Andrea ; Manari, Antonio ; Mehran, Roxana ; Ardissino, Diego ; De Palma, Rossana. / New-generation drug-eluting stents reduce stent thrombosis and myocardial infarction : A propensity-score-adjusted analysis from the multicenter REAL registry (REgistro Regionale AngiopLastiche Dell'Emilia-Romagna). In: Catheterization and Cardiovascular Interventions. 2015 ; Vol. 85, No. 5. pp. 797-806.
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title = "New-generation drug-eluting stents reduce stent thrombosis and myocardial infarction: A propensity-score-adjusted analysis from the multicenter REAL registry (REgistro Regionale AngiopLastiche Dell'Emilia-Romagna)",
abstract = "Objectives The aim of this study was to compare long-term clinical outcomes in patients treated with new-generation drug-eluting stent (DES) or early-generation DES in a real-world registry. Background New-generation DESs have proved to be more effective and safer than early-generation DES in randomized trials. However, the effects of new-generation DES versus early-generation DES in everyday clinical practice deserve further verification. Methods A propensity-score and inverse-probability weighted analysis of 5,332 patients undergoing DES implantation (2,557 new-generation and 2,775 early-generation) between January 1, 2007 and June 30, 2011 was performed, with a median follow-up of 3 years. We assessed the incidence of major adverse cardiovascular events (MACE: all-cause death, nonfatal myocardial infarction [MI], and target vessel revascularization [TVR]), and angiographic stent thrombosis (ST) during follow-up. Results At 3-years, new-generation DES in comparison with early-generation DES were associated with a reduced risk of MI (5{\%} versus 7.4{\%}, hazard ratio [HR] = 0.65, 95{\%} confidence interval [CI] = 0.51-0.82, P = 0.0004) and angiographic ST (0.5{\%} vs. 1.1{\%}, HR = 0.35, 95{\%} CI 0.17-0.72, P = 0.004), whereas, the risk of TVR (10.9{\%} vs. 13.5{\%}; HR 0.99, 95{\%} CI 0.84-1.16, P = 0.99) and overall MACE was not significantly different (19.2{\%} vs. 22.4{\%}, HR = 0.94, 95{\%} CI = 0.83-1.07, P = 0.35). Conclusions Our data from a large all-comers multicenter registry confirm that, in comparison with early-generation DES, the use of new-generation DES is associated with similar efficacy and increased long-term safety, because of a reduced risk of ST and MI.",
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author = "Luigi Vignali and Francesco Saia and Belotti, {Laura Maria Beatrice} and Emilia Solinas and Paolo Guastaroba and Andrea Rubboli and Antonio Manari and Roxana Mehran and Diego Ardissino and {De Palma}, Rossana",
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T1 - New-generation drug-eluting stents reduce stent thrombosis and myocardial infarction

T2 - A propensity-score-adjusted analysis from the multicenter REAL registry (REgistro Regionale AngiopLastiche Dell'Emilia-Romagna)

AU - Vignali, Luigi

AU - Saia, Francesco

AU - Belotti, Laura Maria Beatrice

AU - Solinas, Emilia

AU - Guastaroba, Paolo

AU - Rubboli, Andrea

AU - Manari, Antonio

AU - Mehran, Roxana

AU - Ardissino, Diego

AU - De Palma, Rossana

PY - 2015/4/1

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N2 - Objectives The aim of this study was to compare long-term clinical outcomes in patients treated with new-generation drug-eluting stent (DES) or early-generation DES in a real-world registry. Background New-generation DESs have proved to be more effective and safer than early-generation DES in randomized trials. However, the effects of new-generation DES versus early-generation DES in everyday clinical practice deserve further verification. Methods A propensity-score and inverse-probability weighted analysis of 5,332 patients undergoing DES implantation (2,557 new-generation and 2,775 early-generation) between January 1, 2007 and June 30, 2011 was performed, with a median follow-up of 3 years. We assessed the incidence of major adverse cardiovascular events (MACE: all-cause death, nonfatal myocardial infarction [MI], and target vessel revascularization [TVR]), and angiographic stent thrombosis (ST) during follow-up. Results At 3-years, new-generation DES in comparison with early-generation DES were associated with a reduced risk of MI (5% versus 7.4%, hazard ratio [HR] = 0.65, 95% confidence interval [CI] = 0.51-0.82, P = 0.0004) and angiographic ST (0.5% vs. 1.1%, HR = 0.35, 95% CI 0.17-0.72, P = 0.004), whereas, the risk of TVR (10.9% vs. 13.5%; HR 0.99, 95% CI 0.84-1.16, P = 0.99) and overall MACE was not significantly different (19.2% vs. 22.4%, HR = 0.94, 95% CI = 0.83-1.07, P = 0.35). Conclusions Our data from a large all-comers multicenter registry confirm that, in comparison with early-generation DES, the use of new-generation DES is associated with similar efficacy and increased long-term safety, because of a reduced risk of ST and MI.

AB - Objectives The aim of this study was to compare long-term clinical outcomes in patients treated with new-generation drug-eluting stent (DES) or early-generation DES in a real-world registry. Background New-generation DESs have proved to be more effective and safer than early-generation DES in randomized trials. However, the effects of new-generation DES versus early-generation DES in everyday clinical practice deserve further verification. Methods A propensity-score and inverse-probability weighted analysis of 5,332 patients undergoing DES implantation (2,557 new-generation and 2,775 early-generation) between January 1, 2007 and June 30, 2011 was performed, with a median follow-up of 3 years. We assessed the incidence of major adverse cardiovascular events (MACE: all-cause death, nonfatal myocardial infarction [MI], and target vessel revascularization [TVR]), and angiographic stent thrombosis (ST) during follow-up. Results At 3-years, new-generation DES in comparison with early-generation DES were associated with a reduced risk of MI (5% versus 7.4%, hazard ratio [HR] = 0.65, 95% confidence interval [CI] = 0.51-0.82, P = 0.0004) and angiographic ST (0.5% vs. 1.1%, HR = 0.35, 95% CI 0.17-0.72, P = 0.004), whereas, the risk of TVR (10.9% vs. 13.5%; HR 0.99, 95% CI 0.84-1.16, P = 0.99) and overall MACE was not significantly different (19.2% vs. 22.4%, HR = 0.94, 95% CI = 0.83-1.07, P = 0.35). Conclusions Our data from a large all-comers multicenter registry confirm that, in comparison with early-generation DES, the use of new-generation DES is associated with similar efficacy and increased long-term safety, because of a reduced risk of ST and MI.

KW - drugs

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KW - revascularization

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KW - thrombosis

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