Objectives: The aim of this study was to compare long-term clinical outcomes in patients treated with new-generation DES or early-generation DES in a real-world registry. Background: New-generation drug-eluting stents have proved to be more effective and safer than early-generation DES in randomized trials. However, the effects of new-generation DES vs. early-generation DES in everyday clinical practice deserve further verification. Methods: A propensity-score and inverse-probability weighted analysis of 5332 patients undergoing DES implantation (2557 new- and 2775 early-generation) between January 1, 2007 and June 30, 2011 was performed, with a median follow-up of three years. We assessed the incidence of major adverse cardiovascular events (MACE: all-cause death, non-fatal myocardial infarction [MI], and target vessel revascularization [TVR]) and angiographic stent thrombosis (ST) during follow-up. Results: At 3-years, new-generation DES in comparison with early-generation DES were associated with a reduced risk of MI (5% vs 7.4%, hazard ratio [HR] = 0.65, 95% confidence interval [CI] = 0.51-0.82, p=0.0004) and angiographic stent thrombosis (0.5% vs 1.1%, HR = 0.35, 95% CI 0.17-0.72, p=0.004), whereas the risk of TVR (10.9% vs 13.5%; HR 0.99, 95% CI 0.84-1.16, p=0.99) and overall MACE was not significantly different (19.2% vs 22.4%, HR=0.94, 95% CI= 0.83-1.07, p=0.35). Conclusions: Our data from a large all-comers multicenter registry confirm that, in comparison with early-generation DES, the use of new-generation DES is associated with similar efficacy and increased long-term safety, because of a reduced risk of stent thrombosis and MI. © 2014 Wiley Periodicals, Inc.

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