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Comparative effectiveness of different contemporary drug-eluting stents in routine clinical practice

a multigroup propensity score analysis using data from the stent-specific, multicenter, prospective registries

Kwon, Osunga,*; Kang, Se Hunc,*; Lee, Jung-Bokb; Ahn, Jung-Mina; Lee, Cheol Hyuna; Kang, Do-Yoona; Lee, Pil Hyunga; Kang, Soo-Jina; Lee, Seung-Whana; Kim, Young-Haka; Lee, Cheol Whana; Park, Seong-Wooka; Park, Duk-Wooa; Park, Seung-Junga for the IRIS-DES Registry Investigators

doi: 10.1097/MCA.0000000000000730
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Objective Data on the comparative effectiveness of contemporary drug-eluting stents (DES) in the unrestricted, real-world setting are limited. We investigated the long-term effectiveness and safety of contemporary different drug-eluting stents by means of multiple treatment propensity score weighting.

Patients and methods From seven stent-specific, prospective DES registries conducted between July 2007 and July 2015, we evaluated 17 196 patients who received several contemporary DES and first-generation DES: 3053 treated with cobalt–chromium everolimus-eluting stents (CoCr-EES), 2985 with platinum–chromium EES (PtCr-EES), 2922 with Resolute zotarolimus-eluting stents (Re-ZES), 789 with Biomatrix biolimus-eluting stents (Bi-BES), 1907 with Nobori biolimus-eluting stents (No-BES), 1970 with Xience Prime cobalt–chromium everolimus-eluting stents (Pr-CoCr-EES), and 3570 with sirolimus-eluting stents (SES). The primary outcome was target-vessel failure (a composite of cardiac death, target-vessel myocardial infarction, or target-vessel revascularization) at 3 years of follow-up and major cardiovascular adverse events (a composite of all-cause death, any myocardial infarction, or any revascularization) was also evaluated.

Results The observed 3-year rates of target-vessel failure were not significantly different among different second-generation DES and SES (CoCr-EES 9.8%, PtCr-EES 9.5%, Re-ZES 9.3%, Bi-BES 9.8%, No-BES 7.7%, Pr-CoCr-EES 10.4%, SES 10.2%; overall P=0.07). In multiple treatment propensity score analysis, adjusted hazard ratios for target-vessel failure were similar in between-group comparisons of several contemporary DES. In addition, no significant differences were observed with respect of the adjusted risk of major adverse cardiac events.

Conclusion In this comparative effectiveness research using stent-specific, clinical practice registries involving unrestricted use of several contemporary DES, there were no significant between-group differences in the 3-year rates of target-vessel failure.

aDepartment of Internal Medicine, Division of Cardiology

bDepartment of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul

cDepartment of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea

* Osung Kwon and Se Hun Kang contributed equally to the writing of this article.

Correspondence to Duk-Woo Park, MD, PhD, Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: +82 230 103 995; fax: +82 247 56898; e-mail: dwpark@amc.seoul.kr

Received October 21, 2018

Received in revised form February 12, 2019

Accepted February 18, 2019

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