Ten-year clinical outcomes after drug-eluting stents implantation according to clinical presentation-Insights from the DECADE cooperation

Fabian Starnecker; J J Coughlan; Lisette Okkels Jensen; Sarah Bär; Sebastian Kufner; Salvatore Brugaletta; Lorenz Räber; Michael Maeng; Luis Ortega-Paz; Dik Heg; Karl-Ludwig Laugwitz; Manel Sabaté; Stephan Windecker; Adnan Kastrati; Kevin Kris Warnakula Olesen; Salvatore Cassese

doi:10.1111/eci.14323

Ten-year clinical outcomes after drug-eluting stents implantation according to clinical presentation-Insights from the DECADE cooperation

Eur J Clin Invest. 2024 Oct 1:e14323. doi: 10.1111/eci.14323. Online ahead of print.

Authors

Fabian Starnecker^{1

2}, J J Coughlan³, Lisette Okkels Jensen⁴, Sarah Bär⁵, Sebastian Kufner¹, Salvatore Brugaletta⁶, Lorenz Räber⁵, Michael Maeng⁷, Luis Ortega-Paz⁸, Dik Heg⁹, Karl-Ludwig Laugwitz^{2

10}, Manel Sabaté^{6

11}, Stephan Windecker⁵, Adnan Kastrati^{1

2}, Kevin Kris Warnakula Olesen⁷, Salvatore Cassese¹

Affiliations

¹ Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
² DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.
³ Cardiovascular Research Institute, Mater Private Network, Dublin, Ireland.
⁴ Department of Cardiology, Odense University Hospital, Odense, Denmark.
⁵ Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
⁶ Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
⁷ Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
⁸ Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA.
⁹ Clinical Trials Unit Bern, University of Bern, Bern, Switzerland.
¹⁰ Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
¹¹ Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), CIBERCV CB16/11/00411, Madrid, Spain.

PMID: 39351821
DOI: 10.1111/eci.14323

Abstract

Background: Investigations of very long-term outcomes after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) according to clinical presentation are scarce. Here, we investigated the 10-year clinical outcomes of patients undergoing DES-PCI according to clinical presentation.

Methods: Patient-level data from five randomized trials with 10-year follow-up after DES-PCI were pooled. Patients were dichotomized into acute coronary syndrome (ACS) or chronic coronary syndrome (CCS) groups as per clinical presentation. The primary outcome was all-cause death. Secondary outcomes were cardiovascular death, myocardial infarction (MI), definite stent thrombosis (ST) and repeat revascularization involving the target lesion (TLR), target vessel (TVR) or non-target vessel (nTVR).

Results: Of the 9700 patients included in this analysis, 4557 presented with ACS and 5143 with CCS. Compared with CCS patients, ACS patients had a higher risk of all-cause death and nTVR in the first year, but comparable risk thereafter. In addition, ACS patients had a higher risk of MI [adjusted hazard ratio 1.21, 95% confidence interval (1.04-1.41)] and definite ST [adjusted hazard ratio 1.48, 95% confidence interval (1.14-1.92)], while the risk of TLR and TVR was not significantly different up to 10-year follow-up.

Conclusions: Compared to CCS patients, ACS patients treated with PCI and DES implantation have an increased risk of all-cause death and repeat revascularization of remote vessels up to 1 year, with no significant differences thereafter and up to 10-year follow-up. ACS patients have a consistently higher risk of MI and definite ST. Whether these differences persist with current antithrombotic and secondary prevention therapies requires further investigation.

Keywords: NSTE‐ACS; STEMI; acute coronary syndrome; chronic coronary syndrome; drug‐eluting stents; percutaneous coronary intervention.