Comparison of 4.5-Year Outcomes of Bare-Metal and Zotarolimus-Eluting Stents in New York

Background: Both bare-metal stents (BMS; the first-generation coronary stent) and zotarolimus-eluting stents (ZES; a second-generation drug-eluting stent [DES]) have been widely utilized to treat coronary heart disease. However, the long-term comparative effectiveness of BMS and ZES remains unclear. The purpose of this study was to evaluate long-term comparative effectiveness of BMS versus ZES. Methods: We created a longitudinal database by linking the New York State (NYS) cardiac registries, statewide hospital discharge data, the National Death Index (NDI), and the U.S. Census file (2010) for patients receiving either BMS or ZES during the 2008-2009 period. We examined the rates of all-cause mortality, acute myocardial infarction (AMI), target-lesion PCI (TLPCI), and target-vessel coronary artery bypass graft (TVCABG) surgery for a follow-up period of 4.5 years. A total of 10,443 propensity score matched pairs were compared using the Kaplan-Meier method and Cox proportional hazards regression adjusting for patient risk factors. Results: We found that patients receiving ZES had a lower rate of 4.5-year mortality (adjusted hazard ratio AHR: 0.68, 95% confidence interval CI: 0.63-0.73), AMI (AHR: 0.89, 95% CI: 0.80-0.98), and TVCABG (AHR: 0.84, 95% CI: 0.71-0.99) but a similar rate of TLPCI (AHR: 1.02, 95% CI: 0.93-1.12). For off-label and high-risk subgroups, ZES was associated with improved mortality and generally better or non-inferior AMI, TLPCI, and TVCABG outcomes relative to BMS. Conclusions: Compared with BMS, ZES was associated with lower long-term mortality, AMI and TVCABG.