Five-year clinical outcomes of first-generation versus second-generation drug-eluting stents following coronary chronic total occlusion intervention

Background There are limited data comparing long-term clinical outcomes between first-generation(1G) and second-generation( G) drug-eluting stents(DESs) in patients who underwent successful percutaneous coronary intervention(PCI) for coronary chronic total occlusion(CTO) lesion. Methods A total of 840 consecutive patients who underwent PCI with DESs for CTO lesion from January 2004 to November 2015 were enrolled. Finally, a total of 324 eligible CTO patients received 1G-DES(Paclitaxel-eluting stent or Sirolimus-eluting stent, n = 157) or 2G-DES(Zotarolimus-eluting stent or Everolimus-eluting stent, n = 167) were enrolled. The clinical endpoint was the occurrence of major adverse cardiac events(MACE) defined as all-cause death, recurrent myocardial infarction(re-MI), total repeat revascularization [target lesion revascularization(TLR), target vessel revascularization(TVR), and non-TVR]. We investigated the 5-year major clinical outcomes between 1G-DES and 2G-DES in patient who underwent successful CTO PCI. Results After propensity score matched(PSM) analysis, two well-balanced groups(111 pairs, n = 222, C-statistic = 0.718) were generated. Up to the 5-year follow-up period, the cumulative incidence of all-cause death, re-MI, TLR, TVR and non-TVR were not significantly different between the two groups. Finally, MACE was also similar between the two groups(HR = 1.557, 95% CI: 0.820–2.959, P = 0.176) after PSM. Conclusions In this study, 2G-DES was not associated with reduced long-term MACE compared with 1G-DES following successful CTO revascularization up to five years.