Long-term comparative effectiveness of paclitaxel-eluting and everolimus-eluting stents in New York.
OBJECTIVE
First generation paclitaxel-eluting stents (PES) and second generation everolimus-eluting stents (EES) were approved for use in percutaneous coronary interventions (PCIs) in 2004 and 2008, respectively. However, relative long-term outcomes of PES vs EES in real practice remain unclear. We sought to determine the long-term comparative effectiveness of PES vs EES using New York State (NYS) cardiac registries and to assess long-term outcomes of PES vs ZES in six "off-label" and two "high-risk" patient subgroups.


METHODS
A longitudinal database was built by linking the NYS cardiac registries, the statewide hospital discharge data, the National Death Index, and the 2010 U.S. Census file for patients undergoing either PES or EES implantation from July 2008 through December 2009. All-cause mortality, acute myocardial infarction (AMI), target lesion PCI (TLPCI), and target vessel coronary artery bypass graft (TVCABG) surgery were assessed for 9760 propensity score matched patients in the 5-year follow-up period by using the Kaplan-Meier method with further adjustment using Cox proportional hazards regression.


RESULTS
We found that compared with patients receiving PES, patients receiving EES had a significantly lower rate of 5-year TLPCI (adjusted hazard ratio <AHR>: 0.75, 95% confidence interval <CI>: 0.65-0.86), TVCABG (AHR: 0.69, 95% CI: 0.53-0.90) and a similar rate of all-cause mortality (AHR: 0.98, 95% CI: 0.87-1.10) and AMI (AHR: 0.97, 95% CI: 0.83-1.13). We observed similar findings in only two out of eight subgroups.


CONCLUSIONS
At 5years, EES was associated with lower TLPCI and TVCABG rates and comparable mortality and AMI rates relative to PES.
['Qian|Feng|F|', 'Zhong|Ye|Y|', 'Hannan|Edward L|EL|']
D000368:Aged D000369:Aged, 80 and over D015906:Angioplasty, Balloon, Coronary D017023:Coronary Angiography D023921:Coronary Stenosis D054855:Drug-Eluting Stents D000068338:Everolimus D005260:Female D005500:Follow-Up Studies D006801:Humans D053208:Kaplan-Meier Estimate D008137:Longitudinal Studies D008297:Male D008875:Middle Aged D009518:New York D017239:Paclitaxel D057216:Propensity Score D016016:Proportional Hazards Models D012042:Registries D012189:Retrospective Studies D018570:Risk Assessment D012720:Severity of Illness Index D015996:Survival Rate D013997:Time Factors D016896:Treatment Outcome
Paclitaxel-eluting stents (PES) Everolimus-eluting stents (EES) Long-term outcome