The journey of drug-eluting stents: a multi-centre Australian Registry Review.

Abstract

Background: Drug-eluting stents (DES) were introduced in Australia in 2002. Initial use was restricted to high-restenosis-risk patients, due to cost and late stent thrombosis concerns, particularly the first-generation type. This study reviewed the Melbourne Interventional Group (MIG) experience of percutaneous coronary intervention (PCI) with DES to examine trends, outcomes, and compare the long-term morality of first-generation to later-generation stent types.

Method: Consecutive patients who underwent DES PCI from the MIG registry between 2005 and 2017 were analysed with yearly comparison. National Death Index (NDI) linkage was used to determine 5-year mortality and for Cox proportional hazards modelling.

Results: A total of 15,329 procedures were captured. Major trends are shown below. Twelve-month target vessel revascularisation (available until 2011) was 3.56% compared to 5.75% in 2005 (p = 0.09). Five-year mortality (available until 2012) was 12.1% compared to 12.8% in 2005 (p = 0.25). There was no difference in long-term mortality between first-generation and later-generation DES (22.2% vs 23.6%, p = 0.86). First-generation DES was not an independent predictor of long-term mortality (HR 1.11, 95% CI 0.91–1.36, p = 0.30).

Conclusion: Uptake of DES was slow, but they are now almost universally recommended. There was no evidence of higher long-term mortality with first-generation DES in this Australian multi-centre registry.