Impact of the one-year angioscopic findings on long-term clinical events in 504 patients treated with first-generation or second-generation drug-eluting stents: the DESNOTE-X study

Introduction: The polymers releasing the drug of first-generation drug-eluting stents (DES) may induce allergic reactions and inflammation, resulting in late-acquired stent malapposition (LASM) with uncoverage of struts, and risk of stent thrombosis. The incidence and predictors of LASM in DES with different polymers designed to improve biocompatibility are unknown. Methods: Fifty patients with 59 lesions of interest were randomized to elective treatment with Everolimus-eluting stents (EES; n=17, 20 lesions)], Zotarolimus-eluting stents (ZES; n=15, 19 lesions), and Biolimus-eluting stents (BES; n=18, 20 lesions) and underwent optical coherence tomography after implantation and after one year. Results: After implantation 29 early stent malappositions (ESM) were documented in 29 lesions (49% of lesions), distributed to 11 lesions treated with EES (55%), 11 with ZES (58%), and 7 with BES (35%; n.s.). After one year 14 late stent malappositions (LSM) in 14 lesions (24%) were detected; nine ESM persisted (EPSM) after one year (1 EES, 6 ZES, 2 BES), whereas 20 ESM resolved. In addition, 9 LASM were documented (5 LASM in early well-apposed Stents, 4 LASM in Stents which also have EPSM). LASM was present in 7 hydrophilic polymer-coated ZESs (37%), in 2 fluoropolymer-coated EESs (10%), and in none of the biodegradable polymer-coated BESs (p=0.003). Independent predictors of LASM were the vessel treated (RCA as vessel with high motion; p<0.022) and type of polymer (biodegradable or permanent; p<0.035). Conclusion: The incidence of ESM and EPSM were similar, whereas the incidence of LASM was different in second-generation DES with different polymers. Biodegradable polymer prevented LASM, stent locations with significant vessel movement (RCA) enhanced LASM.

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TCT-198 Comparing Long-term Outcomes of First-Generation and Second-Generation Drug Eluting Stents in Patients with Coronary Artery Disease

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2018.08.1316 ◽

2018 ◽

Vol 72 (13) ◽

pp. B84

Author(s):

Parth Parikh ◽

Kinjal Banerjee ◽

Amar Krishnaswamy ◽

ravi nair ◽

Russell Raymond ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

First Generation ◽

Second Generation ◽

Drug Eluting Stents ◽

Long Term Outcomes ◽

Drug Eluting ◽

Artery Disease

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Premature Discontinuation of Dual Antiplatelet Therapy After Coronary Stenting in Veterans: Characteristics and Long‐Term Outcomes

Journal of the American Heart Association ◽

10.1161/jaha.120.018481 ◽

2021 ◽

Author(s):

Scott Kinlay ◽

Lien Quach ◽

Jean Cormack ◽

Natalie Morgenstern ◽

Ying Hou ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

First Generation ◽

Second Generation ◽

Dual Antiplatelet Therapy ◽

Coronary Intervention ◽

Adverse Outcomes ◽

Drug Eluting Stents ◽

Percutaneous Coronary ◽

Drug Eluting

Background Premature discontinuation of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention is related to higher short‐term risks of adverse outcomes. Whether these risks persist in the long‐term is uncertain. Methods and Results We assessed all patients having percutaneous coronary intervention with coronary second‐ or first‐generation drug‐eluting stents in the Veterans Affairs healthcare system between 2006 and 2012 who were free of major ischemic or bleeding events in the first 12 months. The characteristics of patients who stopped DAPT prematurely (1–9 months duration), compared with >9 to 12 months, or extended duration (>12 months) were assessed by odds ratios (ORs) from multivariable logistic models. The risk of adverse clinical outcomes over a mean 5.1 years in patients who stopped DAPT prematurely was assessed by hazard ratios (HRs) and 95% CIs from Cox regression models. A total of 14 239 had second‐generation drug‐eluting stents, and 8583 had first‐generation drug‐eluting stents. Premature discontinuation of DAPT was more likely in Black patients (OR, 1.54; 95% CI, 1.40–1.68), patients with greater frailty (OR, 1.04; 95% CI, 1.03–1.05), and patients with higher low‐density lipoprotein cholesterol, and less likely in patients on statins (OR, 0.87; 95% CI, 0.80–0.95). Patients who stopped DAPT prematurely had higher long‐term risks of death (second‐generation drug‐eluting stents: HR, 1.35; 95% CI, 1.19–1.56), myocardial infarction (second‐generation drug‐eluting stents: HR, 1.46; 95% CI, 1.22–1.74), and repeated coronary revascularization (second‐generation drug‐eluting stents: HR, 1.24; 95% CI, 1.08–1.41). Conclusions Patients who stop DAPT prematurely have features that reflect greater frailty, poorer medication use, and other social factors. They continue to have higher risks of major adverse outcomes over the long‐term and may require more intensive surveillance many years after percutaneous coronary intervention.

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Outcomes in Patients Fully Covered With Coronary Artery Aneurysm and Stenosis Lesion by Second Generation Drug-Eluting Stents After 1 Year

Angiology ◽

10.1177/0003319720944346 ◽

2020 ◽

Vol 71 (10) ◽

pp. 942-947

Author(s):

Zhiming Wu ◽

Chen Xu ◽

Wei You ◽

Fei Ye ◽

Xiangqi Wu

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Second Generation ◽

Coronary Artery Aneurysm ◽

Artery Aneurysm ◽

Coronary Intervention ◽

Drug Eluting Stents ◽

Clinical Events ◽

Drug Eluting ◽

One Year

We evaluated the safety and efficacy of second-generation drug-eluting stents (DES) fully covering a coronary artery aneurysm (CAA) and stenosis lesion. Patients (n = 33) with CAA and stenosis lesion (>60%) were enrolled between January 2014 and December 2017. Baseline characteristics and biochemical variables were recorded during hospital admission. Changes in CAA resolution (the reduction on CAA size), minimal lumen diameter (MLD), and diameter stenosis (DS) were determined before, just after, and 1 year after percutaneous coronary intervention (PCI). After DES implantation, MLD and DS after PCI were improved compared with those before PCI ( P < .01). Also, thrombolysis in myocardial infarction blood flow was significantly enhanced after PCI ( P < .01). One year after PCI, maximal CAA diameter in patients with CAA and stenosis lesion was significantly reduced compared with those just after PCI ( P < .01). Meanwhile, CAA resolution ratio in these patients were more than those just after PCI ( P < .01). Furthermore, there was a significant reduction about CAA length in these patients ( P < .01). Last, there were no clinical events (including cardiac death, myocardial infarction, and revascularization) in the study. Second-generation DES implantation fully covering CAA and stenosis lesion was safe and effective.

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