Aims: To evaluate whether the improved outcomes with newer generation drug-eluting stents (DES) utilising thin-strut stents are consistent among different patient and angiographic subgroups.
Methods and results: Clinical outcomes over three years were collected in the SPIRIT III trial comparing the XIENCE V® everolimus-eluting stents (EES) (Abbott Vascular, Santa Clara, CA, USA) to the TAXUS® paclitaxel-eluting stents (PES) (Boston Scientific, Natick, MA, USA). Potential predictors of adverse clinical outcomes were assessed using demographic, clinical, and procedural variables by logistic and Cox regression analyses. For three-year target vessel failure, the independent predictors identified by Cox regression were number of vessels treated (HR=2.19 [1.50, 3.19], p<0.0001), HbA1c (%) (HR=1.17 [1.05, 1.29], p=0.004), total cholesterol (>200 mg/dl) (HR=1.63 [1.13, 2.36], p=0.009), and female gender (HR=1.42 [1.01, 2.01], p=0.05). Logistic regression analysis identified the same predictors except for the female gender. The clinical results with EES compared to PES were consistent among the multiple subgroups examined with the possible exception of patients with diabetes.
Conclusions: Clinical factors and stent type were the most important multivariable predictors of adverse clinical outcomes in this contemporary trial of first versus second generation DES. The benefit of the EES compared to the PES was consistent across a wide range of patient and angiographic subgroups with the possible exception of patients with diabetes.