SCAAR Demonstrates Lower Risks Associated With New-Generation DES
August 30, 2011—The European Society of Cardiology (ESC) announced that results from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry) study were presented at the ESC Congress 2011 in Paris, France. The data showed that percutaneous coronary intervention (PCI) with new-generation drug-eluting stents (DES) was associated with a 38% lower risk of clinically meaningful restenosis and a 50% lower risk of stent thrombosis compared to old-generation DES.
The purpose of this study was to evaluate long-term outcomes in all patients who underwent stent implantation with bare-metal stents (BMS), old-generation DES, and new-generation DES in Sweden using SCAAR, a national registry with complete consecutive enrollment.
As detailed by the ESC, SCAAR holds data on consecutive patients from 29 centers that perform coronary angiography and PCI in Sweden. The registry is sponsored by the Swedish Health Authorities and is independent of commercial funding. The technology is developed and administered by the Uppsala Clinical Research Center. Since 2001, SCAAR has been Internet-based, with recording of data online through an Internet interface in the catheterization laboratory; data are transferred in an encrypted format to a central server at the Uppsala Clinical Research Center. All consecutive patients undergoing coronary angiography or PCI are included. Information with respect to restenosis and stent thrombosis has been registered for patients undergoing any subsequent coronary angiography for a clinical reason since the beginning of 2004.
As detailed by the ESC, the study included 94,384 stent implantations in Sweden (BMS, n = 64,631; old-generation DES, n = 19,202; new-generation DES, n = 10,551) from November 2006 to October 2010. The investigators evaluated the performance of different types of new-generation DES in an unselected, large, real-world population up to 2 years after intervention. The study included patients with myocardial infarction, three-vessel and/or left main disease, bifurcation lesions, graft disease, restenotic lesions, and chronic total occlusions.
The investigators noted that further studies are needed to attempt to discriminate whether one of the three components of the new-generation DES—the polymer, the stent alloy, or the drug—is mainly involved in decreasing the incidence of stent thrombosis and restenosis. They stated that improved stent designs with thinner struts and more biocompatible polymers may have an important impact on drug-elution profiles, endothelial coverage, and functional recovery.
The study showed that patients treated with PCI with new-generation DES have a considerably lower risk of restenosis and stent thrombosis at 2 years compared to old-generation DES in a large real world population, the investigators concluded. They advised that these findings could be useful for managing patients with high-risk profiles who may benefit from these new devices.