Comparative effectiveness of different contemporary drug-eluting stents in routine clinical practice: a multigroup propensity score analysis using data from the stent-specific, multicenter, prospective registries Osung Kwon a, *, Se Hun Kang c, *, Jung-Bok Lee b , Jung-Min Ahn a , Cheol Hyun Lee a , Do-Yoon Kang a , Pil Hyung Lee a , Soo-Jin Kang a , Seung-Whan Lee a , Young-Hak Kim a , Cheol Whan Lee a , Seong-Wook Park a , Duk-Woo Park a and Seung-Jung Park a ; for the IRIS-DES Registry Investigators Objective Data on the comparative effectiveness of contemporary drug-eluting stents (DES) in the unrestricted, real-world setting are limited. We investigated the long-term effectiveness and safety of contemporary different drug- eluting stents by means of multiple treatment propensity score weighting. Patients and methods From seven stent-specific, prospective DES registries conducted between July 2007 and July 2015, we evaluated 17 196 patients who received several contemporary DES and first-generation DES: 3053 treated with cobalt–chromium everolimus-eluting stents (CoCr-EES), 2985 with platinum–chromium EES (PtCr- EES), 2922 with Resolute zotarolimus-eluting stents (Re- ZES), 789 with Biomatrix biolimus-eluting stents (Bi-BES), 1907 with Nobori biolimus-eluting stents (No-BES), 1970 with Xience Prime cobalt–chromium everolimus-eluting stents (Pr-CoCr-EES), and 3570 with sirolimus-eluting stents (SES). The primary outcome was target-vessel failure (a composite of cardiac death, target-vessel myocardial infarction, or target-vessel revascularization) at 3 years of follow-up and major cardiovascular adverse events (a composite of all-cause death, any myocardial infarction, or any revascularization) was also evaluated. Results The observed 3-year rates of target-vessel failure were not significantly different among different second- generation DES and SES (CoCr-EES 9.8%, PtCr-EES 9.5%, Re-ZES 9.3%, Bi-BES 9.8%, No-BES 7.7%, Pr-CoCr-EES 10.4%, SES 10.2%; overall P = 0.07). In multiple treatment propensity score analysis, adjusted hazard ratios for target- vessel failure were similar in between-group comparisons of several contemporary DES. In addition, no significant differences were observed with respect of the adjusted risk of major adverse cardiac events. Conclusion In this comparative effectiveness research using stent-specific, clinical practice registries involving unrestricted use of several contemporary DES, there were no significant between-group differences in the 3-year rates of target-vessel failure. Coron Artery Dis 30:255–262 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. Coronary Artery Disease 2019, 30:255–262 Keywords: coronary artery disease, drug-eluting stents, percutaneous coronary intervention a Department of Internal Medicine, Division of Cardiology, b Department of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul and c Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea Correspondence to Duk-Woo Park, MD, PhD, Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea Tel: + 82 230 103 995; fax: + 82 247 56898; e-mail: dwpark@amc.seoul.kr *Osung Kwon and Se Hun Kang contributed equally to the writing of this article. Received 21 October 2018 Revised 12 February 2019 Accepted 18 February 2019 Introduction For the treatment of significant coronary artery disease, the use of drug-eluting stents (DES) has been shown to be more effective in the prevention of restenosis and reduction of repeat revascularization than the use of bare- metal stents (BMS) [1]. Since the introduction of first- generation DES older than 10 years ago, the technology and engineering of DES have continuously advanced [2]. Several types of newer-generation DES have been developed that use different antiproliferative drugs with improved drug release kinetics, novel stent materials, thinner strut platforms, easier delivery system, and more biocompatible or biodegradable polymers than their predecessors. These newer-generation DES were asso- ciated with better safety outcomes not only compared with first-generation DES but also even compared with BMS [3–8], and led to the rapid replacement of first- generation DES in routine clinical practice. Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website, www.coronary-artery.com. Original research 255 0954-6928 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/MCA.0000000000000730 Copyright r 2019 Wolters Kluwer Health, Inc. All rights reserved.