Comparison of Different Types of Drug-Eluting Stents for De Novo Long Coronary Artery Lesions

Do-Yoon Kang; Jae-Sik Jang; Mineok Chang; Cheol Hyun Lee; Pil Hyung Lee; Jung-Min Ahn; Seung-Whan Lee; Young-Hak Kim; Seong-Wook Park; Duk-Woo Park; Seung-Jung Park; LONG-DES Investigators

doi:10.1016/j.jacasi.2022.02.009

Comparison of Different Types of Drug-Eluting Stents for De Novo Long Coronary Artery Lesions

JACC Asia. 2022 May 24;2(4):446-456. doi: 10.1016/j.jacasi.2022.02.009. eCollection 2022 Aug.

Affiliations

¹ Department of Cardiology, Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
² Division of Cardiology, Busan Paik Hospital, University of Inje College of Medicine, Busan, South Korea.
³ Department of Cardiology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
⁴ Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, South Korea.

Abstract

Background: Outcomes of percutaneous coronary intervention for diffuse long lesions remain relatively unfavorable. Prior clinical trials investigated the relative efficacy and safety of different types of drug-eluting stents (DES) in long lesions.

Objectives: This study sought to compare the relative performance of different types of DES for de novo long (≥25 mm) coronary artery lesions.

Methods: Using a pooled analysis of individual data of 1,450 patients from 3 randomized clinical trials, we compared angiographic and clinical outcomes of 5 different types of DES: 224 patients with cobalt-chromium everolimus-eluting stents (EES), 255 with platinum-chromium EES, 250 with Resolute zotarolimus-eluting stents, 245 with biodegradable polymer biolimus-eluting stents, and 476 with first-generation sirolimus-eluting stents (SES). The primary endpoint was in-segment late lumen loss at 9 months.

Results: The primary endpoint was not significantly different between 4 second-generation DES and 1 first-generation SES (0.17 ± 0.41 mm in cobalt-chromium EES; 0.11 ± 0.37 in platinum-chromium EES: 0.14 ± 0.38 in Resolute zotarolimus-eluting stents; 0.14 ± 0.38 in biodegradable polymer biolimus-eluting stents; or 0.10 ± 0.37 in SES, respectively, overall P = 0.38). Also, there were no significant between-group differences with respect to death, myocardial infarction, target-vessel revascularization, or stent thrombosis at 12 months. In the multiple treatment propensity-score analysis, the risk of angiographic and clinical outcomes was also similar among several types of DES.

Conclusions: In this patient-level pooled analysis, several second-generation DES showed similar angiographic and clinical outcomes in patients with de novo long coronary lesions. (Percutaneous Treatment of LONG Native Coronary Lesions With Drug-Eluting Stent-III [LONG-DES-III]; NCT01078038; Percutaneous Treatment of LONG Native Coronary Lesions With Drug-Eluting Stent-IV [LONG-DES-IV]; NCT01186094; and Everolimus-eluting [PROMUS-ELEMENT] vs. Biolimus A9-Eluting [NOBORI] Stents for Long-Coronary Lesions [LONG-DES-V]; NCT01186120).

Keywords: BES, biolimus-eluting stent(s); DES, drug-eluting stent(s); EES, everolimus-eluting stent(s); MACE, major adverse cardiac event(s); MI, myocardial infarction; PCI, percutaneous coronary intervention; PtCr, platinum chromium; SES, sirolimus-eluting stent(s); TLR, target-lesion revascularization; TVR, target-vessel revascularization; coronary artery disease; drug-eluting stents; percutaneous coronary intervention.

Associated data

ClinicalTrials.gov/NCT01186120