Why the study?
It is controversial whether contemporary bioresorbable-polymer drug-eluting stents are associated with better outcomes compared with durable-polymer drug-eluting stents.
Do bioresorbable-polymer everolimus-eluting stents improve 1-year MACE compared to durable-polymer everolimus-eluting stents in patients undergoing percutaneous coronary intervention?
Observational (n=5,446)
No
Do bioresorbable-polymer everolimus-eluting stents improve 1-year MACE compared to durable-polymer everolimus-eluting stents in patients undergoing percutaneous coronary intervention?
Contemporary bioresorbable-polymer and durable-polymer everolimus-eluting stents demonstrate comparable 1-year clinical outcomes, including in patients undergoing complex PCI.
OBJECTIVES: We aimed to evaluate the 1-year outcomes of three everolimus-eluting stents (EES) for complex percutaneous coronary intervention (PCI). BACKGROUND: It is controversial whether contemporary bioresorbable-polymer drug-eluting stents (BP-DES) are associated with better outcomes compared with durable-polymer DES (DP-DES). METHODS: Patients undergoing PCI with cobalt-chromium (CoCr)-DP-EES (Xience), platinum-chromium (PtCr)-DP-EES (Promus), or PtCr-BP-EES (Synergy) at one high-volume institution between 2015 and 2017 were included. The primary endpoint was 1-year major adverse cardiac events (MACE), a composite of death, myocardial infarction, and target-vessel revascularization. Associations were also examined in patients undergoing complex PCI. Multivariable analysis was conducted to adjust for baseline differences across groups. RESULTS: We included n = 5,446 patients (CoCr-DP-EES, n = 3,177; PtCr-DP-EES, n = 1,555; PtCr-BP-EES, n = 714). Patients treated with PtCr-BP-EES had higher comorbidity burden and procedural complexity. At 1 year, MACE rates were 8.9% for CoCr-DP-EES versus 8.9% for PtCr-DP-EES versus 8.6% for PtCr-BP-EES (p = .97). The incidence of definite/probable stent thrombosis (ST) was also similar (0.6 vs. 0.4 vs. 0.3%, p = .69). Complex PCI was performed in n = 2,894/5,446 (53.1%). At 1 year, MACE rates were 11.5 versus 10.7 versus 10.3%, respectively (p = .83). The incidence of definite/probable ST was also similar (0.9 vs. 0.3 vs. 0.3%, p = .22). On multivariable analysis, stent type was not an independent predictor of MACE either in the overall or in the complex PCI population. CONCLUSIONS: We observed comparable 1-year rates of MACE and definite/probable ST in patients undergoing PCI with CoCr-DP-EES, PtCr-DP-EES, and PtCr-BP-EES. Results were unchanged among patients undergoing complex PCI. Future multicenter randomized studies should confirm and extend our findings.
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Azzalini et al. (2020) conducted an observational in Complex percutaneous coronary intervention (PCI) (n=5,446). PtCr-BP-EES (Synergy) vs. CoCr-DP-EES (Xience) and PtCr-DP-EES (Promus) was evaluated on 1-year major adverse cardiac events (MACE), a composite of death, myocardial infarction, and target-vessel revascularization (p=0.97).
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