Major ischaemic and bleeding risks following current drug-eluting stent implantation: Are there differences across current drug-eluting stent types in real life?

Background: Current drug-eluting stents (c-DESs) reduce the occurrence of ischaemic events, but expose recipients to stent thrombosis and bleeding secondary to preventive antiplatelet therapy. To date, comparative data on the relative effectiveness and safety of the various c-DESs in real life are limited.

Aim: To compare ischaemic and bleeding risks across the major c-DESs used in France.

Methods: French national health insurance reimbursement and hospitalization databases were used. Patients implanted with a c-DES in 2014 were followed for 1 year. The risks of ischaemic events (revascularization, myocardial infarction and/or stroke), major bleeding events and death were compared across six c-DESs (XIENCE, PROMUS, RESOLUTE, BIOMATRIX, NOBORI and ORSIRO), using multilevel Cox models adjusted for baseline individual and hospital characteristics.

Results: A total of 52,891 subjects were included: 34.4% with XIENCE; 27.6% with PROMUS; 24.0% with RESOLUTE; 8.0% with BIOMATRIX; 5.0% with NOBORI; and 1.0% with ORSIRO. Among them, 9378 had at least one event (ischaemic, 6064; major bleeding, 1968; death, 2411), resulting in an overall incidence rate of 19 per 100 person-years. In the multivariable analysis, the risk of ischaemic events, major bleeding events or death did not differ between the c-DESs overall (adjusted hazard ratios between 0.85 [95% confidence interval 0.68-1.07] and 1.04 [95% confidence interval 0.98-1.10] compared with XIENCE used as the reference) and when each outcome was considered separately.

Conclusions: In real life, major ischaemic and bleeding risks do not differ across the various c-DESs over the first year following implantation. Future studies are needed to assess comparative c-DES effectiveness and safety longer term.