Comparison of first‐ and second‐generation drug‐eluting stents in patients with ST‐segment elevation myocardial infarction based on pre‐percutaneous coronary intervention thrombolysis in myocardial infarction flow grade

This study aims to investigate the two‐year clinical outcomes between first‐generation (1G) and second‐generation (2G) drug‐eluting stents (DES) based on pre‐percutaneous coronary intervention (PCI) thrombolysis in myocardial infarction (TIMI) flow grade (pre‐TIMI) in patients with ST‐segment elevation myocardial infarction (STEMI). Overall, 17,891 STEMI patients were classified into two groups: pre‐TIMI 0/1 group (n = 12,862; 1G‐DES (n = 4318), 2G‐DES (n = 8544)) and pre‐TIMI 2/3 group (n = 5029; 1G‐DES (n = 2046), 2G‐DES (n = 2983)). During a two‐year followup period, major adverse cardiac events (MACEs) defined as all‐cause death, recurrent myocardial infarction (re‐MI), or any repeat revascularization and stent thrombosis (ST) were considered as the primary and the secondary outcomes. In the pre‐TIMI 0/1 and 2/3 groups, the cumulative incidences of MACEs (adjusted hazard ratio (aHR): 1.348, p < 0.001, and aHR: 1.415, p = 0.02, respectively) and any repeat revascularization (aHR: 1.938, p < 0.001, and aHR: 1.674, p = 0.001, respectively) were significantly higher in the 1G‐DES than in the 2G‐DES. However, sirolimus‐eluting stent showed similar cumulative incidence of any repeat revascularization compared with zotarolimus‐eluting stent and biolimus‐eluting stent in both pre‐TIMI 0/1 and 2/3 groups. The cumulative incidences of all‐cause death, re‐MI, and ST were similar between the 1G‐DES and 2G‐DES groups. In this study, 2G‐DES showed better clinical outcomes than 1G‐DES concerning MACEs and any repeat revascularization regardless of pre‐TIMI. However, more research is needed to support these results.