Outcomes After First- Versus Second-Generation Drug-Eluting Stent Thrombosis (From the REAL-ST Registry)

Abstract Limited data exist on the comparison of clinical outcomes after first- and second-generation drug-eluting stent (DES) thrombosis. From the REAL-ST registry (Retrospective Multicenter Registry of Stent Thrombosis [ST] After First- and Second- Generation DES Implantation), this study evaluated 655 ST patients (first-generation DES thrombosis [G1-ST], n=342; second-generation DES thrombosis [G2-ST], n=313). After propensity score matching, the final study population consisted of 159 matched patients. The primary endpoint was the cumulative 1-year incidence of mortality. The mortality after G2-ST at 1 year was similar to that after G1-ST (23.0% vs. 22.9%, p=0.76). Also, the G2-ST group showed a significantly lower rate of target lesion revascularization than the G1-ST group (9.7% vs. 17.1%, p=0.01). Risk factors of 1-year mortality included cardiogenic shock or arrest at the time of ST, multivessel ST, left ventricular ejection fraction ≤40%, advanced age, and final thrombosis in myocardial infarction flow grade ≤2. In conclusion, patients with G2-ST showed a similar 1-year mortality to those with G1-ST, highlighting that ST remains a life-threatening complication in the second-generation DES era.