Key result
SES requires a lower post-stent area threshold than BMS to achieve 90% patency.
Why the study?
The predictive value of minimum stent area (MSA) for long-term patency after sirolimus-eluting stent implantation compared to bare metal stents was uncertain due to biologic variability in restenosis.
Does minimum stent area predict long-term patency differently in sirolimus-eluting stents compared to bare metal stents?
Cohort (n=122)
Does minimum stent area predict long-term patency differently in sirolimus-eluting stents compared to bare metal stents?
Absolute Event Rate: 90% vs 56%
Sirolimus-eluting stents have a lower optimal minimum stent area threshold (5 mm2) to predict long-term patency compared to bare metal stents (6.5 mm2).
OBJECTIVES: We assessed the predictive value of minimum stent area (MSA) for long-term patency of sirolimus-eluting stents (SES) implantation compared to bare metal stents (BMS). BACKGROUND: Although MSA is a consistent predictor of in-stent restenosis, its predictive value in BMS is still limited because of biologic variability in the restenosis process. METHODS: From the SIRolImUS (SIRIUS) trial, 122 cases (SES: 72; BMS: 50) with complete serial intravascular ultrasound (IVUS) (baseline and 8-month follow-up) were analyzed. Postprocedure MSA and follow-up minimum lumen area (MLA) were obtained. Based on previous physiologic studies, adequate stent patency at follow-up was defined as MLA >4 mm(2). RESULTS: In both groups, a significant positive correlation was observed between baseline MSA and follow-up MLA (SES: p < 0.0001, BMS: p < 0.0001). However, SES showed higher correlation than BMS (0.8 vs. 0.65) with a higher regression coefficient (0.92 vs. 0.59). The sensitivity and specificity curves identified different optimal thresholds of MSA to predict adequate follow-up MLA: 5 mm(2) for SES and 6.5 mm(2) for BMS. The positive predictive values with these cutoff points were 90% and 56%, respectively. CONCLUSIONS: In this SIRIUS IVUS substudy, SES reduced both biologic variability and restenosis, resulting in increased predictability of long-term stent patency with postprocedure MSA. In addition, SES had a considerably lower optimal MSA threshold compared to BMS.
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Sonoda et al. (2004) reported a cohort. Sirolimus-eluting stents vs. Bare metal stents was evaluated on Positive predictive value of optimal minimum stent area threshold for adequate follow-up minimum lumen area (>4 mm2). Sirolimus-eluting stents had a lower optimal minimum stent area threshold (5 mm2) to predict adequate follow-up patency compared to bare metal stents (6.5 mm2), with PPVs of 90% and 56%.
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