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Research Article                                                                                             Online First
Five-year clinical outcomes of first-generation versus second-generation drug-eluting stents following coronary chronic total occlusion intervention
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Authors:Yong Hoon Kim1;Ae-Young Her1;Seung-Woon Rha2;Byoung Geol Choi3;Se Yeon Choi4;Jae Kyeong Byun4;Yoonjee Park5;Dong Oh Kang5;Won Young Jang5;Woohyeun Kim5;Ju Yeol Baek6;Woong Gil Choi7;Tae Soo Kang8;Jihun Ahn9;Sang-Ho Park10;Ji Young Park11;Min-Ho Lee12;Cheol Ung Choi13;Chang Gyu Park13;Hong Seog Seo13

Author Affiliation:1.Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, South Korea;2.Cardiovascular Center, Korea University Guro Hospital, Seoul, South Korea;Department of Medicine, Korea University Graduate School, Seoul, South Korea;3.Cardiovascular Center, Korea University Guro Hospital, Seoul, South Korea;4.Department of Medicine, Korea University Graduate School, Seoul, South Korea;5.Cardiovascular Center, Korea University Guro Hospital, Seoul, South Korea;6.Cardiovascular Center, Seoul St. Mary’s Hospital, the Catholic University of Korea, Seoul, South Korea;7.Cardiology Department, Konkuk University Chungju Hospital, Chungju, South Korea;8.Department of Internal Medicine, Cardiovascular Division, Dankook University Hospital, Cheonan, South Korea;9.Department of Cardiology, Soonchunhyang University Gumi Hospital, Gumi, South Korea;10.Cardiology Department, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea;11.Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Nowon Eulji Medical Center, Eulji University, Seoul, South Korea;12.Department of Cardiology, Soonchunhyang University College of Medicine, Seoul, South Korea;13.Cardiovascular Center, Korea University Guro Hospital, Seoul, South Korea;


Abstract: Background There are limited data comparing long-term clinical outcomes between first-generation (1G) and second-generation (2G) 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.


Chronic total occlusion; Drug-eluting stent; Outcomes
Received:December 30, 2018        Accepted:February 12, 2019   Published Online:August 28, 2019
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