Long-Term Outcomes After Revascularization for Stable Ischemic Heart Disease: An Individual Patient-Level Pooled Analysis of 19 Randomized Coronary Stent Trials. Review uri icon

Overview

abstract

  • BACKGROUND: Whether revascularization improves prognosis in stable ischemic heart disease is controversial. METHODS: Individual patient-level data from 19 prospective, randomized stent trials were pooled. Rates of 5-year major adverse cardiovascular events (MACE; a composite of cardiac death, myocardial infarction, or ischemia-driven target lesion revascularization) were assessed and compared after percutaneous coronary intervention with bare-metal stents (BMS) and first-generation and second-generation drug-eluting stents (DES1 and DES2, respectively). Poisson multivariable regression analysis was performed to identify predictors of adverse events. RESULTS: Among 10 987 patients treated with percutaneous coronary intervention for stable ischemic heart disease, 1550, 2776, and 6661 received BMS, DES1, and DES2, respectively. The 5-year rates of MACE progressively declined with evolution in stent technology (BMS: 24.1% versus DES1: 17.9% versus DES2: 13.4%, P<0.0001). However, MACE rates between 1 and 5 years increased from BMS to DES1, then declined with DES2 (BMS: 7.4% versus DES1: 10.2%, DES2: 8.5%, P=0.02). CONCLUSIONS: Patients with stable ischemic heart disease remain at substantial risk for long-term MACE after revascularization with percutaneous coronary intervention, even with contemporary DES. New approaches to reduce the ongoing risk of MACE beyond 1 year after stent implantation are necessary.

authors

  • Madhavan, Mahesh V
  • Redfors, Bjorn
  • Ali, Ziad A
  • Prasad, Megha
  • Shahim, Bahira
  • Smits, Pieter C
  • von Birgelen, Clemens
  • Zhang, Zixuan
  • Mehran, Roxana
  • Serruys, Patrick W
  • Maehara, Akiko
  • Leon, Martin B
  • Kirtane, Ajay J
  • Stone, Gregg W

publication date

  • April 13, 2020

Research

keywords

  • Drug-Eluting Stents
  • Myocardial Ischemia
  • Percutaneous Coronary Intervention

Identity

Scopus Document Identifier

  • 85083168908

Digital Object Identifier (DOI)

  • 10.1161/CIRCINTERVENTIONS.119.008565

PubMed ID

  • 32279561

Additional Document Info

volume

  • 13

issue

  • 4