Ten‐year clinical outcomes after drug‐eluting stents implantation according to clinical presentation—Insights from the DECADE cooperation.

Background: Investigations of very long‐term outcomes after percutaneous coronary intervention (PCI) with drug‐eluting stents (DES) according to clinical presentation are scarce. Here, we investigated the 10‐year clinical outcomes of patients undergoing DES‐PCI according to clinical presentation. Methods: Patient‐level data from five randomized trials with 10‐year follow‐up after DES‐PCI were pooled. Patients were dichotomized into acute coronary syndrome (ACS) or chronic coronary syndrome (CCS) groups as per clinical presentation. The primary outcome was all‐cause death. Secondary outcomes were cardiovascular death, myocardial infarction (MI), definite stent thrombosis (ST) and repeat revascularization involving the target lesion (TLR), target vessel (TVR) or non‐target vessel (nTVR). Results: Of the 9700 patients included in this analysis, 4557 presented with ACS and 5143 with CCS. Compared with CCS patients, ACS patients had a higher risk of all‐cause death and nTVR in the first year, but comparable risk thereafter. In addition, ACS patients had a higher risk of MI [adjusted hazard ratio 1.21, 95% confidence interval (1.04–1.41)] and definite ST [adjusted hazard ratio 1.48, 95% confidence interval (1.14–1.92)], while the risk of TLR and TVR was not significantly different up to 10‐year follow‐up. Conclusions: Compared to CCS patients, ACS patients treated with PCI and DES implantation have an increased risk of all‐cause death and repeat revascularization of remote vessels up to 1 year, with no significant differences thereafter and up to 10‐year follow‐up. ACS patients have a consistently higher risk of MI and definite ST. Whether these differences persist with current antithrombotic and secondary prevention therapies requires further investigation. [ABSTRACT FROM AUTHOR]