Two-year outcomes after first- or second-generation drug-eluting or bare-metal stent implantation in all-comer patients undergoing percutaneous coronary intervention: a pre-specified analysis from the PRODIGY study (PROlonging Dual Antiplatelet Treatment After Grading stent-induced Intimal hyperplasia studY).

Abstract

OBJECTIVES:

This study sought to assess device-specific outcomes after implantation of bare-metal stents (BMS), zotarolimus-eluting Endeavor Sprint stents (ZES-S), paclitaxel-eluting stents (PES), or everolimus-eluting stents (EES) (Medtronic Cardiovascular, Santa Rosa, California) in all-comer patients undergoing percutaneous coronary intervention.

BACKGROUND:

Few studies have directly compared second-generation drug-eluting stents with each other or with BMS.

METHODS:

We randomized 2,013 patients to BMS, ZES-S, PES, or EES implantation. At 30 days, each stent group received up to 6 or 24 months of clopidogrel therapy. The key efficacy endpoint was the 2-year major adverse cardiac event (MACE) including any death, myocardial infarction, or target vessel revascularization, whereas the cumulative rate of definite or probable stent thrombosis (ST) was the key safety endpoint.

RESULTS:

Clinical follow-up at 2 years was complete for 99.7% of patients. The MACE rate was lowest in EES (19.2%; 95% confidence interval [CI]: 16.0 to 22.8), highest in BMS (32.1%; 95% CI: 28.1 to 36.3), and intermediate in PES (26.2%; 95% CI: 22.5 to 30.2) and ZES-S (27.8%; 95% CI: 24.1 to 31.9) groups (chi-square test = 18.9, p = 0.00029). The 2-year incidence of ST in the EES group (1%; 95% CI: 0.4 to 2.2) was similar to that in the ZES-S group (1.4%; 95% CI: 0.7 to 2.8), whereas it was lower compared with the PES (4.6%, 95% CI: 3.1 to 6.8) and BMS (3.6%; 95% CI: 2.4 to 5.6) groups (chi-square = 16.9; p = 0.0001).

CONCLUSIONS:

Our study shows that cumulative MACE rate, encompassing both safety and efficacy endpoints, was lowest for EES, highest for BMS, and intermediate for PES and ZES-S groups. EES outperformed BMS also with respect to the safety endpoints with regard to definite or probable and definite, probable, or possible ST. (PROlonging Dual antiplatelet treatment after Grading stent-induced Intimal hyperplasia studY [PRODIGY]; NCT00611286).

• Authors: Marco Valgimigli, Matteo Tebaldi, Marco Borghesi, Pascal Vranckx, Gianluca Campo, Carlo Tumscitz, Elisa Cangiano, Monica Minarelli, Antonella Scalone, Caterina Cavazza, Jlenia Marchesini, Giovanni Parrinello, PRODIGY Investigators
• Journal: JACC. Cardiovascular interventions (JACC Cardiovasc Interv) Vol. 7 Issue 1 Pg. 20-8 (Jan 2014) ISSN: 1876-7605 [Electronic] United States
• PMID: 24332420 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Metals
• Platelet Aggregation Inhibitors
• Everolimus
• Clopidogrel
• zotarolimus
• Ticlopidine
• Paclitaxel
• Sirolimus

Topics

• Aged, 80 and over
• Chi-Square Distribution
• Clopidogrel
• Coronary Restenosis (diagnosis, etiology, mortality, prevention & control)
• Coronary Thrombosis (etiology, prevention & control)
• Drug Administration Schedule
• Drug Therapy, Combination
• Drug-Eluting Stents
• Everolimus
• Female
• Humans
• Hyperplasia
• Italy
• Kaplan-Meier Estimate
• Male
• Metals
• Middle Aged
• Myocardial Infarction (etiology, prevention & control)
• Neointima
• Paclitaxel (administration & dosage)
• Percutaneous Coronary Intervention (adverse effects, instrumentation, mortality)
• Platelet Aggregation Inhibitors (administration & dosage)
• Prosthesis Design
• Risk Factors
• Sirolimus (administration & dosage, analogs & derivatives)
• Stents
• Ticlopidine (administration & dosage, analogs & derivatives)
• Time Factors
• Treatment Outcome