Key result
Bioresorbable polymer drug-eluting stents resulted in similar rates of target lesion revascularization compared to durable polymer stents at 16 months in patients with unprotected left main or bifurcation stenosis.
Why the study?
Data are limited regarding the impact of bioresorbable polymer vs durable polymer DES in patients undergoing PCI with ultrathin stents for left main or bifurcation stenosis.
Does bioresorbable polymer drug-eluting stent (BP-DES) reduce target lesion revascularization compared to durable polymer drug-eluting stent (DP-DES) in patients with unprotected left main or bifurcation stenosis treated with ultrathin stents?
Observational (n=1,400)
Yes
Does bioresorbable polymer drug-eluting stent (BP-DES) reduce target lesion revascularization compared to durable polymer drug-eluting stent (DP-DES) in patients with unprotected left main or bifurcation stenosis treated with ultrathin stents?
In patients with bifurcation or unprotected left main lesions treated with ultrathin stents, bioresorbable polymer DES perform similarly to durable polymer DES, with potential benefits in two-stent strategies.
Answers are grounded in this paper and cite their sources.
Comparable revascularization rates with bioresorbable polymer stents in left main lesions; hypothesis-generating and requires randomized confirmation.
BACKGROUND: There are limited data regarding the impact of bioresorbable polymer drug eluting stent (BP-DES) compared to durable polymer drug eluting stent (DP-DES) in patients treated with percutaneous coronary intervention using ultrathin stents in left main or bifurcations. METHODS: In the RAIN registry (ClinicalTrials NCT03544294, june 2018 retrospectively registered) patients with a ULM or bifurcation stenosis treated with PCI using ultrathin stents (struts thinner than 81 μm) were enrolled. The primary endpoint was the rate of target lesion revascularization (TLR); major adverse cardiovascular events (MACE, a composite of all-cause death, myocardial infarction, TLR and stent thrombosis) and its components, along with target vessel revascularization (TVR) were the secondary ones. A propensity score with matching analysis to compare patients treated with BP-DES versus DP-DES was also assessed. RESULTS: From 3001 enrolled patients, after propensity score analysis 1400 patients (700 for each group) were selected. Among them, 352 had ULM disease and 1048 had non-LM bifurcations. At 16 months (12-22), rates of TLR (3.7% vs 2.9%, p = 0.22) and MACE were similar (12.3% vs. 11.6%, p = 0.74) as well as for the other endpoints. Sensitivity analysis of outcomes after a two-stents strategy, showed better outcome in term of MACE (20.4% vs 10%, p = 0.03) and TVR (12% vs 4.6%, p = 0.05) and a trend towards lower TLR in patients treated with BP-DES. CONCLUSION: In patients with bifurcations or ULM treated with ultrathin stents BP-DES seems to perform similarly to DP-DES: the trends toward improved clinical outcomes in patients treated with the BP-DES might potentially be of value for speculating the stent choice in selected high-risk subgroups of patients at increased risk of ischemic events. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03544294. Retrospectively registered June 1, 2018.
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Iannaccone et al. (2020) conducted an observational in Unprotected left main or bifurcation stenosis (n=1,400). Bioresorbable polymer drug-eluting stent (BP-DES) vs. Durable polymer drug-eluting stent (DP-DES) was evaluated on Target lesion revascularization (TLR) (p=0.22). Bioresorbable polymer drug-eluting stents resulted in similar rates of target lesion revascularization compared to durable polymer stents at 16 months in patients with unprotected left main or bifurcation stenosis.
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