Impact of current smoking on 2-year clinical outcomes between durable-polymer-coated stents and biodegradable-polymer-coated stents in acute myocardial infarction after successful percutaneous coronary intervention: Data from the KAMIR

Abstract

Objective: Data concerning the effect of current smoking on solely new-generation drug-eluting stents (DES) are limited. We investigated the impact of current smoking on 2-year clinical outcomes between durable-polymer (DP)-coated DES (zotarolimus-eluting [ZES] and everolimus eluting [EES]) and biodegradable-polymer (BP)-coated biolimus-eluting stent (BES) in acute myocardial infarction (AMI) patients after successful percutaneous coronary intervention (PCI).

Methods: Finally, a total of 8357 AMI patients with current smoking underwent successful PCI with new-generation DES (ZES, EES, and BES) were enrolled and divided into three groups as ZES (n = 3199), EES (n = 3987), and BES group (n = 1171). The primary endpoint was the occurrence of major adverse cardiac events (MACE) defined as all-cause death (cardiac death [CD] or non-cardiac death), recurrent AMI (re-MI), 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).

Results: The 2-year adjusted hazard ratio (HR) of MACE for ZES vs. EES (1.055; 95% confidence interval [CI], 0.843-1.321; p = 0.638), ZES vs. BES (HR, 0.885; 95% CI, 0.626-1.251; p = 0.488), EES vs. BES (HR, 0.889; 95% CI, 0.633-1.250; p = 0.499), and ZES/EES vs. BES (HR, 0.891; 95% CI, 0.648-1.126; p = 0.480) were similar. The occurrence of ST after adjustment were also comparable. In addition, the 2-year adjusted HR for all-cause death, CD, re-MI, TLR, TVR, and non-TVR were not different.

Conclusions: In this study, DP-DES and BP-DES showed comparable safety and efficacy during 2-year follow-up periods. Therefore, DP-DES or BP-DES are equally acceptable in AMI patients with current smoking undergoing PCI.

Fig 1. Flow chart.

AMI, acute myocardial infarction; KAMIR, Korea Acute Myocardial Infarction Registry; PCI, percutaneous coronary intervention; BMS, bare-metal stent; CABG, coronary artery bypass graft; DES, drug-eluting stents; ZES, zotarolimus-eluting stents; EES, everolimus-eluting stents; BES, biolimus-eluting stents. *Non-smoker was defined as who did not regularly smoke at any time. ^†Ex-smoker was defined as who had stopped smoking for more than 1 year before the index PCI

Fig 2

Kaplan-Meier Curved Analysis for MACE (A) and stent thrombosis (B) at 2-year before adjustment. MACE, major adverse cardiac event; ZES, zotarolimus-eluting stent; EES, everolimus-eluting stent; BES, biolimus-eluting stent; HR, hazard ratio; CI, confidence interval.

Fig 3

Kaplan-Meier Curved Analysis for all–cause death (A), Re-MI (B), TLR (C), and TVR (D). MI, myocardial infarction; ZES, zotarolimus-eluting stent; EES, everolimus-eluting stent; BES, biolimus-eluting stent; HR, hazard ratio; CI, confidence interval; TLR, target lesion revascularization; TVR, target vessel revascularization.

Fig 4. Subgroup analysis for MACE.

MACE, major adverse cardiac events; AMI, acute myocardial infarction; STEMI, ST-segment elevation myocardial infarction; NSTEMI, non-ST-segment elevation myocardial infarction; LVEF,: left ventricular ejection fraction; BMI, body-mass index; ACEI, angiotensin converting enzyme inhibitors; BB, beta-blockers; LAD, left anterior descending; ACC/AHA, American College of Cardiology/American Heart Association; PCI, percutaneous coronary intervention; TIMI, Thrombolysis In Myocardial Infarction; DP-DES, durable-polymer drug-eluting stents; BP-DES, biodegradable-polymer DES.