Long-Term Outcomes after Revascularization for Stable Ischemic Heart Disease: An Individual Patient-Level Pooled Analysis of 19 Randomized Coronary Stent Trials

Mahesh V. Madhavan, Björn Redfors, Ziad A. Ali, Megha Prasad, Bahira Shahim, Pieter C. Smits, Clemens Von Birgelen, Zixuan Zhang, Roxana Mehran, Patrick W. Serruys, Akiko Maehara, Martin B. Leon, Ajay J. Kirtane, Gregg W. Stone*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

8 Citations (Scopus)

Abstract

Background: Whether revascularization improves prognosis in stable ischemic heart disease is controversial. Methods: Individual patient-level data from 19 prospective, randomized stent trials were pooled. Rates of 5-year major adverse cardiovascular events (MACE; a composite of cardiac death, myocardial infarction, or ischemia-driven target lesion revascularization) were assessed and compared after percutaneous coronary intervention with bare-metal stents (BMS) and first-generation and second-generation drug-eluting stents (DES1 and DES2, respectively). Poisson multivariable regression analysis was performed to identify predictors of adverse events. Results: Among 10 987 patients treated with percutaneous coronary intervention for stable ischemic heart disease, 1550, 2776, and 6661 received BMS, DES1, and DES2, respectively. The 5-year rates of MACE progressively declined with evolution in stent technology (BMS: 24.1% versus DES1: 17.9% versus DES2: 13.4%, P<0.0001). However, MACE rates between 1 and 5 years increased from BMS to DES1, then declined with DES2 (BMS: 7.4% versus DES1: 10.2%, DES2: 8.5%, P=0.02). Conclusions: Patients with stable ischemic heart disease remain at substantial risk for long-term MACE after revascularization with percutaneous coronary intervention, even with contemporary DES. New approaches to reduce the ongoing risk of MACE beyond 1 year after stent implantation are necessary.

Original languageEnglish
Article numbere008565
JournalCirculation: Cardiovascular Interventions
Volume13
Issue number4
DOIs
Publication statusAccepted/In press - 1 Apr 2020
Externally publishedYes

Keywords

  • drug-eluting stent
  • myocardial infarction
  • percutaneous coronary intervention
  • prognosis
  • stents

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