Abstract and Introduction
Abstract
Objective. The objective of the present study was to perform a systematic review and meta-analysis of studies reporting outcomes after first- and second-generation drug-eluting stent (DES) implantation in chronic total occlusions (CTOs).
Background. The effect of second- vs first-generation DESs on the outcomes after CTO percutaneous coronary intervention (PCI) has received limited study.
Methods. As of May 2013, thirty-one published studies reported outcomes after DES implantation in CTOs: thirteen uncontrolled studies (3161 patients), three randomized (220 patients) and ten non-randomized (2150 patients) comparative studies with bare-metal stents (BMSs), and two non-randomized (685 patients) and three randomized (489 patients) comparative studies between first- and second-generation DESs. Data from the five studies comparing first- with second-generation DESs were pooled using random-effects meta-analysis models.
Results. The median and mean duration of follow-up were 12 and 14.4 months, respectively. Compared to first-generation DESs, second-generation DESs were associated with lower incidence of death (odds ratio [OR], 0.37; 95% confidence intervals [CI], 0.15–0.91), target vessel revascularization (OR, 0.59; 95% CI, 0.40–0.87), binary angiographic restenosis (OR, 0.68; 95% CI, 0.46–1.01) and reocclusion (OR, 0.35; 95% CI, 0.17–0.71), but similar incidence of myocardial infarction (OR, 0.45; 95% CI, 0.10–1.95) and stent thrombosis (OR, 0.34; 95% CI, 0.07–1.59).
Conclusions. Compared to first-generation DESs, second-generation DESs are associated with improved angiographic and clinical outcomes in CTO PCI and are the preferred stents for these challenging lesions.
Introduction
Percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs) has been associated with high rates of crossing failure and restenosis. The development of novel devices and techniques has led to significant improvements in procedural success rates, restoring patency of the occluded coronary segments. Similarly, use of first-generation drug-eluting stent (DES) implantation has dramatically improved long-term outcomes after CTO PCI compared to bare-metal stent (BMS) by significantly reducing the risk for in-stent restenosis and the need for repeat coronary revascularization. First-generation DESs had stainless-steel platforms, whereas second-generation DESs have cobalt-chrome or platinum-chrome platforms with thinner strut thickness and more biocompatible, durable polymer coatings. Second-generation DESs have been shown to significantly improve outcomes compared to first-generation DESs in non-CTO lesions, but their impact on CTO PCI has received limited study. The objective of the present study was to perform a systematic review and meta-analysis of studies reporting outcomes after first- and second-generation DES implantation in CTOs.