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Comparison of drug-eluting stents in real-life clinical practice in Sweden: Insights from the SCAAR register. Goran K. Olivecrona 1, Elvin Kedhi 2, Elmir.

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Presentation on theme: "Comparison of drug-eluting stents in real-life clinical practice in Sweden: Insights from the SCAAR register. Goran K. Olivecrona 1, Elvin Kedhi 2, Elmir."— Presentation transcript:

1 Comparison of drug-eluting stents in real-life clinical practice in Sweden: Insights from the SCAAR register. Goran K. Olivecrona 1, Elvin Kedhi 2, Elmir Omerovic 3, Stefan James 4, Jan Harnek 1, J. Gustav Smith 1, Bo Lagerqvist 4 1 Department of Cardiology, Lund University, Lund, Sweden 2 Department of Cardiology, Maasstad Ziekenhuis, Rotterdam, Netherlands, 3 Department of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden, 4Uppsala University Hospital, Uppsala, Sweden. Introduction: The SPIRIT IV and COMPARE trials showed improved safety and efficacy with everolimus- eluting stents (EES) when compared to paclitaxel-eluting stents (PES) and rejected the concept of a class effect for drug-eluting stents. We compared the safety and efficacy of EES and PES in real-life clinical practice in all Swedish PCI centres, using the Swedish Coronary Angiography and Angioplasty register and also extended our analyses to include sirolimus-eluting (SES) and 1 st generation zotarolimus-eluting (ZES) stents. We studied all patients treated with at least one of these stents between Nov 2006 and Feb 2010. EES was compared individually with PES, SES and ZES* for the up to 1-year incidence of clinically driven and detected in- stent restenosis, definite stent thrombosis, and all cause mortality. The Kaplan-Meier estimator was used to compute cumulative hazards and Cox proportional hazards regression to estimate hazard ratios. Propensity score methods were used to adjust for clinical and angiographic baseline differences. Materials and Methods: Conclusions : Results Results: We included 1760, 5112, 3047 and 1778 patients treated with EES, PES, SES and ZES*, respectively. The cumulative 1-year event rates and hazard of in-stent restenosis, definite stent thrombosis and all-cause mortality is presented in the table. Our results corroborate findings from the SPIRIT IV and COMPARE trials in real-life clinical practice, showing that use of Everolimus eluting stents results in significantly lower rates of restenosis. Additionally, trends for reduction in definite stent thrombosis were observed when compared to paclitaxel and Sirolimus eluting stents. Stent Type n (Stents) Restenosis Adjusted Stent Adjusted Mortality Adjusted % (n) Hazard Thrombosis Hazard (patients Hazard Ratio % (n) Ratio with one Ratio (95% CI) (95% CI) stent only) (95% CI) Everolimus 2836 1.8% (52) 1 0.3% (9) 1 1.9% 1 (17/876) Paclitaxel 8841 3.1% (280) 2.11 0.8% (67) 2.3 3.6% 1.33 (1.43-3.11) (0.98-5.61) (92/2498) (0.70-2.54) Sirolimus 4727 3.4% (161) 1.60 0.8% (39) 2.40 2.3% 0.81 (1.01-2.54) (0.85-6.73) (41/1800) (0.34-1.93) Zotarolimus* 2814 6.3% (178) 2.77 1.0% (29) 1.66 4.1% 1.80 (1.69-4.53) (0.48-5.82) (46/910) (0.70-5.15) Everolimus Paclitaxel Sirolimus Zotarolimus * Number of patients (n) 1760 5112 3047 1778 Number of stents (n) 2836 8841 4727 2814 Patient Background Age (mean) (SD) 65.8 (10.4) 66.3 (10.4) 65.4 (10.2) 66.2 (10.5) Female (%) 28.7 27.0 27.0 28.1 Never smoked (%) 41.4 43.4 41.8 43.1 Hypertension treated 64.1 62.4 59.6 58.8 Lipid lowering treatment (%) 64.5 62.3 66.9 66.8 Diabetes (%) 27.0 27.1 25.5 27.1 Previous acute MI (%) 36.0 35.6 37.2 37.3 Previous PCI (%) 39.0 38.7 42.7 37.0 Previous CABG (%) 13.9 15.6 14.2 16.8 Indication for index procedure Stable Angina (%) 32.9 33.0 36.2 37.2 Unstable Angina/ NSTEMI (%) 53.4 51.5 51.7 57.3 STEMI (%) 11.2 13.0 10.5 9.4 Treated Vesel and Lesion Type LM (%) 2.5 4.0 2.2 2.5 LAD (%) 46.1 43.3 46.5 44.3 Cx (%) 23.3 22.7 21.7 22.6 RCA (%) 24.6 25.1 25.6 25.5 Vein Graft (%) 3.4 4.8 3.7 4.9 Type A lesion (%) 6.0 7.0 6.9 8.1 Type B lesion (%) 62.8 63.6 60.4 62.0 Type C lesion (%) 31.2 29.5 32.7 29.9 Denovo (%) 86.6 86.9 79.6 89.4 In stent restenosis (%) 13.4 13.1 20.4 10.6 CTO (%) 6.4 6.8 7.9 6.6 Stent Length (mm, SD) 18.90 (6.55) 18.93 (7.01) 19.97 (7.10) 18.93 (6.90) Stent Diameter (mm, SD) 2.87 (0.46) 2.98 (0.53) 2.90 (0.44) 2.92 (0.48) Maximum Inflation Pressure (Atm, SD) 18.8 (3.5) 19.2 (3.4) 18.5 (3.4) 17.7 (3.0) Patient Backgrounds Results Restenosis, Adjusted Everolimus vs. Paclitaxel Restenosis, Adjusted Everolimus vs. Zotarolimus* Stent Thrombosis, Adjusted Everolimus vs. Paclitaxel Restenosis, Adjusted Everolimus vs. Sirolimus Stent Thrombosis, Adjusted Everolimus vs. Sirolimus Stent Thrombosis, Adjusted Everolimus vs. Zotarolimus* * 1st Generation Zotarolimus Eluting stents

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