Key result
Bioresorbable-polymer SYNERGY-EES demonstrated significantly better neointimal coverage (80% vs 25% grade 3 coverage; P=0.002) and fewer thrombi (10% vs 40%; P=0.03) than durable-polymer XIENCE-EES.
Why the study?
XIENCE-EES and SYNERGY-EES were developed to prevent delayed arterial healing, but the process of arterial healing after their implantation has not been clarified.
Do bioresorbable-polymer everolimus-eluting stents improve neointimal coverage compared to durable-polymer everolimus-eluting stents in patients undergoing stent implantation?
Cohort (n=40)
Do bioresorbable-polymer everolimus-eluting stents improve neointimal coverage compared to durable-polymer everolimus-eluting stents in patients undergoing stent implantation?
Absolute Event Rate: 80% vs 25%
p-value: p=0.002
Bioresorbable-polymer everolimus-eluting stents demonstrate better neointimal coverage and fewer thrombi at 1 year compared to durable-polymer everolimus-eluting stents, suggesting improved arterial healing.
May support improved healing with bioresorbable-polymer stents; leaves open clinical outcome impact pending RCTs.
OBJECTIVES: We aimed to compare the coronary angioscopic appearance of neointimal coverage (NIC) over durable-polymer everolimus-eluting stents (XIENCE-EES) and bioresorbable-polymer everolimus-eluting stents (SYNERGY-EES) 1 year after implantation. BACKGROUND: XIENCE-EES and SYNERGY-EES have been developed to prevent delayed arterial healing associated with first generation drug-eluting stents. However, the process of arterial healing after XIENCE-EES and SYNERGY-EES implantation has not been clarified. METHODS: Patients who underwent implantation of XIENCE-EES (n = 20) or SYNERGY-EES (n = 20) were enrolled in this study. Coronary angiography and coronary angioscopy were performed 12 ± 1 months after stent implantation. The NIC over the stent was classified into four grades: grade 0, stent struts fully exposed; grade 1, stent struts bulging into the lumen and, still visible; grade 2, stent struts embedded in neointima but still visible; and grade 3, stent struts fully embedded and invisible. Stents exhibiting more than one NIC grade was defined as heterogeneous. Moreover, presence of thrombi was investigated. RESULTS: The distribution of dominant NIC grade (XIENCE-EES: grade 0, 0%; grade 1, 25%; grade 2, 50%; grade 3, 25%; SYNERGY-EES: grade 0, 0%; grade 1, 5%; grade 2, 15%; grade 3, 80%; P = 0.002) and NIC heterogeneity was significantly different (P = 0.004). Thrombi were more frequent in XIENCE-EES than in SYNERGY-EES (40 versus 10%, respectively; P = 0.03). CONCLUSION: Compared with XIENCE-EES, SYNERGY-EES were well covered by neointima and accompanied by fewer thrombi. These findings implied arterial healing of SYNERGY-EES was better than that of XIENCE-EES.
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Nojima et al. (2019) conducted a cohort in Coronary artery disease requiring stent implantation (n=40). Bioresorbable-polymer everolimus-eluting stents (SYNERGY-EES) vs. Durable-polymer everolimus-eluting stents (XIENCE-EES) was evaluated on Dominant neointimal coverage (NIC) grade 3 (p=0.002). Bioresorbable-polymer SYNERGY-EES demonstrated significantly better neointimal coverage (80% vs 25% grade 3 coverage; P=0.002) and fewer thrombi (10% vs 40%; P=0.03) than durable-polymer XIENCE-EES.
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