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Ultrathin-strut vs thin-strut drug-eluting stents for multi and single-stent lesions: A lesion-level subgroup analysis of 2 randomized trials

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Title: Ultrathin-strut vs thin-strut drug-eluting stents for multi and single-stent lesions: A lesion-level subgroup analysis of 2 randomized trials
Authors: Jonas D. Häner, Miklos Rohla, Sylvain Losdat, Juan F. Iglesias, Olivier Muller, Eric Eeckhout, David Kurz, Daniel Weilenmann, Christoph Kaiser, Maxime Tapponnier, Marco Roffi, Dik Heg, Stephan Windecker, Thomas Pilgrim
Source: American heart journal, vol. 263, pp. 73-84
Publisher Information: Elsevier BV, 2023.
Publication Year: 2023
Subject Terms: Myocardial Infarction / epidemiology, Sirolimus, Polymers, Coronary Artery Disease / surgery, Everolimus / pharmacology, Myocardial Infarction, Drug-Eluting Stents, Coronary Artery Disease, Prosthesis Design, 3. Good health, Percutaneous Coronary Intervention, Treatment Outcome, Absorbable Implants, Humans, Coronary Artery Disease/surgery, Everolimus/pharmacology, Myocardial Infarction/epidemiology, Randomized Controlled Trials as Topic, Everolimus
Description: Whether ultrathin-strut stents are particularly beneficial for lesions requiring implantation of more than 1 stent is unknown.In a post-hoc lesion-level analysis of 2 randomized trials comparing ultrathin-strut biodegradable polymer Sirolimus-eluting stents (BP-SES) vs thin-strut durable polymer Everolimus-eluting stents (DP-EES), lesions were stratified into multistent lesions (MSL) vs single-stent lesions (SSL). The primary endpoint was target lesion failure (TLF), a composite of lesion-related unclear/cardiac death, myocardial infarction (MI), or revascularization, at 24 months.Among 5328 lesions in 3397 patients, 1492 (28%) were MSL (722 with BP-SES, 770 with DP-EES). At 2 years, TLF occurred in 63 lesions (8.9%) treated with BP-SES and 60 lesions (7.9%) treated with DP-EES in the MSL-group (subdistibution hazard ratio [SHR], 1.13; 95% CI, 0.77-1.64; P = .53), and in 121 (6.4%) and 136 (7.4%) lesions treated with BP-SES and DP-EES respectively (SHR, 0.86; 95% CI, 0.62-1.18; P = .35) in the SSL-group (P for interaction = .241). While the rates of lesion-related MI or revascularization were significantly lower in SSL treated with BP-SES as compared to DP-EES (3.5% vs 5.2%; SHR, 0.67; 95% CI 0.46-0.97; P = .036), no significant difference was observed in MSL (7.1% vs 5.4%; SHR, 1.31; 95% CI 0.85-2.03; P = .216) with significant interaction between groups (P for interaction = .014).Rates of TLF are similar between ultrathin-strut BP-SES and thin-strut DP-EES in MSL and SSL. The use of ultrathin-strut BP-SES vs thin-strut DP-EES did not prove to be particularly beneficial for the treatment of multistent lesions.Post-hoc analysis from the BIOSCIENCE (NCT01443104) and BIOSTEMI (NCT02579031) trials.
Document Type: Article
File Description: application/pdf
Language: English
ISSN: 0002-8703
DOI: 10.1016/j.ahj.2023.05.004
Access URL: https://pubmed.ncbi.nlm.nih.gov/37192697
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Rights: CC BY
Accession Number: edsair.doi.dedup.....63c9e2b49f1e33264401d991cf70cd4e
Database: OpenAIRE
Description
Abstract:Whether ultrathin-strut stents are particularly beneficial for lesions requiring implantation of more than 1 stent is unknown.In a post-hoc lesion-level analysis of 2 randomized trials comparing ultrathin-strut biodegradable polymer Sirolimus-eluting stents (BP-SES) vs thin-strut durable polymer Everolimus-eluting stents (DP-EES), lesions were stratified into multistent lesions (MSL) vs single-stent lesions (SSL). The primary endpoint was target lesion failure (TLF), a composite of lesion-related unclear/cardiac death, myocardial infarction (MI), or revascularization, at 24 months.Among 5328 lesions in 3397 patients, 1492 (28%) were MSL (722 with BP-SES, 770 with DP-EES). At 2 years, TLF occurred in 63 lesions (8.9%) treated with BP-SES and 60 lesions (7.9%) treated with DP-EES in the MSL-group (subdistibution hazard ratio [SHR], 1.13; 95% CI, 0.77-1.64; P = .53), and in 121 (6.4%) and 136 (7.4%) lesions treated with BP-SES and DP-EES respectively (SHR, 0.86; 95% CI, 0.62-1.18; P = .35) in the SSL-group (P for interaction = .241). While the rates of lesion-related MI or revascularization were significantly lower in SSL treated with BP-SES as compared to DP-EES (3.5% vs 5.2%; SHR, 0.67; 95% CI 0.46-0.97; P = .036), no significant difference was observed in MSL (7.1% vs 5.4%; SHR, 1.31; 95% CI 0.85-2.03; P = .216) with significant interaction between groups (P for interaction = .014).Rates of TLF are similar between ultrathin-strut BP-SES and thin-strut DP-EES in MSL and SSL. The use of ultrathin-strut BP-SES vs thin-strut DP-EES did not prove to be particularly beneficial for the treatment of multistent lesions.Post-hoc analysis from the BIOSCIENCE (NCT01443104) and BIOSTEMI (NCT02579031) trials.
ISSN:00028703
DOI:10.1016/j.ahj.2023.05.004