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April 13, 2020

Pooled Analysis Shows Substantial Long-Term MACE Risk After PCI for Stable Ischemic Heart Disease

April 13, 2020—In Circulation: Cardiovascular Interventions, Mahesh V. Madhavan, MD, et al published findings from an individual patient-level pooled analysis of 19 randomized coronary stent trials evaluating long-term outcomes after revascularization for stable ischemic heart disease.

The investigators assessed and compared rates of 5-year major adverse cardiovascular events (MACE; a composite of cardiac death, myocardial infarction, or ischemia-driven target lesion revascularization) after percutaneous coronary intervention (PCI) with bare-metal stents (BMS) and first- and second-generation drug-eluting stents (DES1 and DES2, respectively). Poisson multivariable regression analysis was performed to identify predictors of adverse events.

As reported in Circulation: Cardiovascular Interventions, the study was composed of 10,987 patients treated with PCI for stable ischemic heart disease with BMS (n = 1,550), DES1 (n = 2,776), or DES2 (n = 6,661).

The investigators found that 5-year rates of MACE progressively declined with evolution in stent technology (24.1% with BMS vs 17.9% with DES1 vs 13.4% with DES2; P < .0001). However, MACE rates between 1 and 5 years increased from BMS to DES1, then declined with DES2 (7.4% with BMS vs 10.2% with DES1 vs 8.5% with DES2; P = .02).

The study concluded that patients with stable ischemic heart disease remain at substantial risk for long-term MACE after revascularization with PCI, even with contemporary DES. New approaches to reduce the ongoing risk of MACE beyond 1 year after stent implantation are necessary, advised the investigators in Circulation: Cardiovascular Interventions.

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