A comparison of the impact of current smoking on 2-year major clinical outcomes of first- and second-generation drug-eluting stents in acute myocardial infarction

Abstract

There are limited studies comparing the effect of current smoking on first-generation (1G)-drug-eluting stents (DES) and second-generation (2G)-DES in acute myocardial infarction (AMI) patients after successful percutaneous coronary intervention (PCI). We investigated the clinical impact of current smoking on 2-year clinical outcomes between the 1G-DES and the 2G-DES in AMI patients after PCI.A total of 11,812 AMI patients with a history of current smoking who underwent successful PCI with 1G-DES (n = 4622) or 2G-DES (n = 7190) were enrolled. The primary endpoint was the occurrence of major adverse cardiac events (MACE) defined as all-cause death, recurrent AMI (re-MI) or any revascularization (target lesion revascularization [TLR], target vessel revascularization [TVR], and non-TVR). The secondary endpoint was the incidence of definite or probable stent thrombosis (ST).Two propensity score-matched (PSM) groups (3900 pairs, n = 7800, C-statistic = .708) were generated. After PSM analysis, the 2-year cumulative incidence of MACE was significantly higher in the 1G-DES group compared with the 2G-DES (9.4% vs 7.4%, Log-rank P = .002; hazard ratio, 1.281; 95% confidence interval, 1.097–1.495; P = .002) and this increased incidence of MACE was associated with the increased incidence of any revascularization including TLR, TVR, and non-TVR. However, the incidences of ST, all-cause death, re-MI were not significantly different during 2-year follow-up period.2G-DES was the preferred treatment strategy for AMI patients with a history of current smoking to reduce MACE especially, any revascularization rate rather than 1G-DES in this study.

ST-segment elevation versus non-ST-segment elevation myocardial infarction in current smokers after newer-generation drug-eluting stent implantation

“…[ 13 ] Successful PCI was defined as residual stenosis < 30% and thrombolysis in myocardial infarction (TIMI) grade 3 flow for the infarct-related artery (IRA) after the procedure. [ 10 ] Aspirin 200 to 300 mg and clopidogrel 300 to 600 mg, or alternatively, ticagrelor 180 mg or prasugrel 60 mg, were prescribed as the loading doses before PCI. The recommended total duration of dual antiplatelet therapy was ≥ 12 months for patients who underwent PCI.…”

“…Recent reports have shown that the major clinical outcomes could differ according to stent generation [ 9 ] and individuals who are current smokers. [ 10 ] However, direct comparative results between STEMI and NSTEMI in patients with AMI and current smokers in the contemporary newer-generation drug-eluting stent (DES) era are limited. Hence, in this study, we compared the 2-year clinical outcomes between STEMI and NSTEMI in patients who are current smokers who underwent successful percutaneous coronary intervention (PCI) with newer-generation DESs.…”

Sex difference after acute myocardial infarction patients with a history of current smoking and long-term clinical outcomes: Results of KAMIR Registry

“…Sixth, the strategy of antiplatelet therapy (e.g., dual antiplatelet therapy or TAPT) was left to the physician's discretion, which may have influenced the major clinical outcomes [9].…”

Real-World Three-Year Clinical Outcomes of Biolimus-Eluting Stents versus Other Contemporary Drug-Eluting Stents in Patients with Acute Myocardial Infarction Patients: Data from the Korea Acute Myocardial Infarction Registry (KAMIR)

“…Durable polymers of first-generation drug-eluting stents (DESs) have safety issues, such as very late stent thrombosis (ST), which is related to adverse clinical outcomes [1]. Recently, biodegradable polymer-coated DESs were reported to be better in reducing very late STand improving clinical outcomes than firstgeneration DES [2]. Biolimus-eluting stents (BES) are polymerfree and carrier-free drug-coated stents that transfer umirolimus (also known as biolimus A9), a highly lipophilic sirolimus analogue, into the vessel wall over a one-month period [3].…”