Safety and Efficacy of New-Generation Drug-Eluting Stents in Women Undergoing Complex Percutaneous Coronary Artery Revascularization: From the WIN-DES Collaborative Patient-Level Pooled Analysis

详细信息    查看全文

• 作者：Gennaro Giustino ; MD^a ; Usman Baber ; MD ; MSc^a ; Melissa Aquino ; MSc^a ; Samantha Sartori ; PhD^a ; Gregg W. Stone ; MD^b ; Martin B. Leon ; MD^b ; Philippe Genereux ; MD^c ; ^d ; ^e ; George D. Dangas ; MD ; PhD^a ; Jaya Chandrasekhar ; MBBS^a ; Takeshi Kimura ; MD^f ; Olga Salianski^a ; Giulio G. Stefanini ; MD ; PhD^g ; P. Gabriel Steg ; MD ; PhD^h ; Stephan Windecker ; MD ; PhDⁱ ; William Wijns ; MD^j ; Patrick W. Serruys ; MD ; PhD^k ; Marco Valgimigli ; MD ; PhD^l ; Marie-Claude Morice ; MD^m ; Edoardo Camenzind ; MDⁿ ; Giora Weisz ; MD^b ; ^o ; Pieter C. Smits ; MD^p ; David E. Kandzari ; MD^q ; Soren Galatius ; MD^r ; Clemens Von Birgelen ; MD^s ; Robert Saporito^s ; Raban V. Jeger ; MD^t ; Ghada W. Mikhail ; MD^u ; Dipti Itchhaporia ; MD^v ; Laxmi Mehta ; MD^w ; Rebecca Ortega ; MHA^x ; Hyo-Soo Kim ; MD^y ; Adnan Kastrati ; MD^z ; Alaide Chieffo ; MD^aa ; Roxana Mehran ; MD^a ; ^{Roxana.Mehran@mountsinai.org" class="auth_mail" title="E-mail the corresponding author}
• 关键词：complex PCI ; drug-eluting stent(s) ; outcomes ; women
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2016
• 出版时间：11 April 2016
• 年：2016
• 卷：9
• 期：7
• 页码：674-684
• 全文大小：1549 K

文摘

The purpose of this study was to investigate the safety and efficacy of new-generation drug-eluting stents (DES) versus early-generation DES in women undergoing complex percutaneous coronary intervention (CPCI).

Background

Whether the benefits of new-generation DES are preserved in women undergoing complex percutaneous revascularization is unknown.

Methods

We pooled patient-level data from women enrolled in 26 randomized trials of DES. Study population was categorized according to the presence or absence of CPCI, which was defined as the composite of total stent length >30 mm, ≥2 stents implanted, ≥2 lesions treated, or bifurcation lesion as target vessel. The primary endpoint was major adverse cardiovascular events (MACE) defined as a composite of all-cause mortality, myocardial infarction, or target lesion revascularization at 3 years of follow-up.

Results

Of 10,241 women included in the pooled database, 4,629 (45%) underwent CPCI. Compared with non-CPCI, women who underwent CPCI had a higher 3-year risk of MACE (adjusted hazard ratio [HR]: 1.63; 95% confidence interval [CI]: 1.45 to 1.83; p < 0.0001). In women who underwent CPCI, use of new-generation DES was associated with significantly lower 3-year risk of MACE (adjusted HR: 0.81; 95% CI: 0.68 to 0.96), target lesion revascularization (adjusted HR: 0.74; 95% CI: 0.57 to 0.95), and definite or probable stent thrombosis (ST) (adjusted HR: 0.50; 95% CI: 0.30 to 0.83). The benefit of new-generation DES on efficacy and safety outcomes was uniform between CPCI and non-CPCI groups, without evidence of interaction. By landmark analysis, new-generation DES were associated with low rates (≤0.4%) of very-late ST irrespective of procedural complexity.

Conclusions

Women undergoing CPCI remain at higher risk of adverse events. The long-term ischemic benefits of new-generation DES platforms are uniform among complex and non-complex percutaneous revascularization procedures in women.