Stent-related adverse events continue to accrue up to 5 years after PCI: JACC
Delhi: Stent-related adverse events continue to accrue at a rate of about 2% per year from 1 to 5 years after the percutaneous coronary intervention (PCI), with all the stent types. Findings, published in the Journal of the American College of Cardiology, are based on a meta-analysis of individual patient data on more than 25,000 patients undergoing PCI with bare-metal and first- and second-generation drug-eluting stents.
The majority of stent-related major adverse cardiovascular events (MACE) after PCI are believed to occur within the first year. Very-late (>1-year) stent-related MACE have not been well described. Mahesh V. Madhavan, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, and colleagues conducted the study to assess the frequency and predictors of very-late stent-related events or MACE by stent type.
For the purpose, the researchers pooled individual patient data from 19 prospective, randomized metallic stent trials maintained at a leading academic research organization.
Very-late MACE (a composite of cardiac death, myocardial infarction [MI], or ischemia-driven target lesion revascularization [ID-TLR]), and target lesion failure (cardiac death, target-vessel MI, or ID-TLR) were assessed within year 1 and between 1 and 5 years after PCI with bare-metal stents (BMS), first-generation drug-eluting stents (DES1) and second-generation drug-eluting stents (DES2). A network meta-analysis was performed to evaluate direct and indirect comparisons.
Among 25,032 total patients, 3,718, 7,934, and 13,380 were treated with BMS, DES1, and DES2, respectively.
Key findings of the study include:
- MACE rates within 1 year after PCI were progressively lower after treatment with BMS versus DES1 versus DES2 (17.9% vs. 8.2% vs. 5.1%, respectively).
- Between years 1 and 5, very-late MACE occurred in 9.4% of patients (including 2.9% cardiac death, 3.1% MI, and 5.1% ID-TLR).
- Very-late MACE occurred in 9.7%, 11.0%, and 8.3% of patients treated with BMS, DES1, and DES2, respectively (p < 0.0001), linearly increasing between 1 and 5 years.
- Similar findings were observed for target lesion failure in 19,578 patients from 12 trials.
- Findings were confirmed in the network meta-analysis.
"In this study, very late stent-related events occurred between 1 and 5 years after PCI at a rate of ∼2%/year with all stent types," wrote the authors. "New approaches are required to improve long-term outcomes after PCI."
The study, "Stent-Related Adverse Events >1 Year After Percutaneous Coronary Intervention," is published in the Journal of the American College of Cardiology.
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