Differences in lesion characteristics and patient background associated with the medium-term clinical outcomes of bare-m
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ORIGINAL ARTICLE
Differences in lesion characteristics and patient background associated with the medium‑term clinical outcomes of bare‑metal and first‑, second‑ and third‑generation drug‑eluting stents Masayuki Nakamura1 · Amane Ike1 · Yuta Kato1 · Makito Futami1 · Takashi Kuwano1 · Makoto Sugihara1 · Atsushi Iwata1 · Akira Kawamura1 · Yasunori Suematsu1 · Shin‑ichiro Miura1,2 Received: 28 April 2020 / Accepted: 28 August 2020 © Springer Japan KK, part of Springer Nature 2020
Abstract We investigated the lesion characteristics and patient background factors associated with the medium-term incidence of major adverse cardiac events (MACEs) for bare-metal stents (BMS) and 1st-, 2nd- and 3rd-generation drug-eluting stents (DES) using the PCI-Registry (FU-Registry). Between January 2003 and March 2016, 2967 cases/3508 lesions for which percutaneous coronary intervention was performed at Fukuoka University Hospital and related facilities were enrolled. Patients were divided into BMS and 1st-, 2nd- and 3rd-generation drug-eluting stent (DES) groups. The incidence of MACEs in the BMS group (26.2%) was significantly higher than those in the 1st, 2nd and 3rd DES groups (18.0%, 12.5%, and 11.0%, respectively). The incidence of MACEs in the BMS group was strongly associated with insulin use, hemodialysis, low highdensity lipoprotein cholesterol, stent minimum lesion diameter, stent length, severe calcification and a small vessel diameter of less than 2.5 mm. Some of these factors showed no association with MACEs among the drug-elution groups, and only hemodialysis, arteriosclerosis obliterans and severe calcification showed a strong correlation in the 2nd DES group. In the 3rd DES group, none of the factors considered were associated with MACEs. In conclusion, in stent implantation, the number of factors associated with MACEs has gradually decreased as the stent generation increased. Keywords Major adverse cardiac events · Bare-metal stent · Drug-eluting stent · Percutaneous coronary intervention
Introduction Since the advent of coronary stents used in percutaneous coronary intervention (PCI), this technology has been repeatedly improved and many issues have been overcome. The development of the first-generation drug-eluting stent (1st DES) markedly decreased the incidence of in-stent restenosis (ISR). However, 1st DES increased the rate of very late stent thrombosis [1]. To solve this problem, a * Amane Ike [email protected] * Shin‑ichiro Miura [email protected]‑u.ac.jp 1
Department of Cardiology, Fukuoka University School of Medicine, 7‑45‑1 Nanakuma, Jonan‑ku, Fukuoka 814‑0180, Japan
Department of Cardiology, Fukuoka University Nishijin Hospital, 15‑7 Sohara, Sawara‑Ku, Fukuoka 814‑8522, Japan
2
second-generation drug-eluting stent (2nd DES) was developed. Although 2nd DES is safer than 1st DES, there are still some issues, such as ISR and stent thrombosis. Bioabsorbable polymers that disappear with drug elution were introduced in third-generation DES (3rd DES) [2, 3]. However, many reports have stated th
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