According to research published early online in the European Heart Journal, percutaneous coronary intervention (PCI) with new-generation drug-eluting stents (n-DES) is associated with a lower risk of clinically meaningful restenosis, definite ST, and death compared with older-generation DES (o-DES).

The authors note that concern has been raised over the long-term safety of the first generation DES, particularly regarding the potential risk of late stent thrombosis.  The design of n-DES may help to overcome the limitations of the o-DES but long-term results from their unrestricted use are limited.  The purpose of the current study was to compare the long-term outcome of patients having PCI with n-DES versus o-DES and bare metal stents (BMS) using data from a national registry.

Researchers used data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR), which holds data on consecutive patients from all centres that perform coronary angiography and PCI in Sweden.  The study included all patients receiving coronary stents from November 2006 to October 2010 (n=94,384).  The stent types were classified as follows: BMS (n=64,631); o-DES (Cypher and Cypher Select, Taxus Express, Taxus Liberté, and Endeavor, n=19,202); n-DES (Endeavor Resolute, XienceV, Xience Prime and Promus, Promus Element; n=10,551).  The predefined endpoints were clinically driven restenosis, definite ST and death.

The authors report the following overall results:

• n-DES were associated with a lower risk of restenosis than BMS (adjusted hazard ratio (HR) 0.29; 95% CI 0.25–0.33) and o-DES (HR 0.62; 95% CI 0.53–0.72).    

• n-DES were associated with a lower risk of definite ST compared to BMS (HR 0.38; 95% CI 0.28–0.52) and o-DES (HR 0.57; 95% CI 0.41–0.79).

• The risk of death was lower in n-DES compared with o-DES (HR 0.77; 95% CI 0.63–0.95) and BMS (adjusted HR: 0.55; 95% CI: 0.46–0.67).

The authors comment that large randomised studies are required to confirm the findings of this observational study.