Key result
Second-generation drug-eluting stents were associated with a significantly smaller thrombus burden at 1 month compared to bare-metal stents in STEMI patients (P=0.04).
Why the study?
G2-DES are associated with lower acute and subacute stent thrombosis than BMS in STEMI, motivating an early-phase comparison of vascular response and thrombus burden.
Does second-generation drug-eluting stent implantation reduce thrombus burden compared to bare-metal stent implantation in patients with STEMI?
Observational (n=41)
No
Does second-generation drug-eluting stent implantation reduce thrombus burden compared to bare-metal stent implantation in patients with STEMI?
Absolute Event Rate: 1.2% vs 1.2%
p-value: p=0.04
Second-generation drug-eluting stents are associated with a significantly smaller thrombus burden at 1 month compared to bare-metal stents in STEMI patients, potentially explaining their lower rates of stent thrombosis.
Associated smaller thrombus burden with second-generation DES in STEMI supports mechanistic hypothesis; leaves open clinical outcome confirmation in RCTs.
Background and Objectives Second‐generation drug‐eluting stents (G2‐DES) are associated with a lower rate of acute and subacute stent thrombosis compared with bare‐metal stent (BMS) in the setting of ST‐segment elevation myocardial infarction (STEMI). In this study, our aim was to compare the vascular response and thrombus burden between G2‐DES and BMS in early‐phase STEMI. Methods Between May 2010 and August 2014, a total of 41 STEMI patients treated by either G2‐DES (n = 26; everolimus‐eluting stent [EES]: n = 15, zotarolimus‐eluting stent [ZES]: n = 11) or BMS (n = 15) and, with multivessel disease requiring additional percutaneous coronary intervention (PCI), were prospectively enrolled. Optical coherence tomography (OCT) imaging was performed at 1 month after stent implantation. Results Baseline clinical characteristics, except for age (61.5 ± 9.3 vs 69.3 ± 9.8, P = 0.01, t test), were comparable between patients with drug‐eluting stent (DES) and BMS. The incidence of residual thrombus after the stent implantation for STEMI was comparable between DES and BMS (7.7% vs 6.7%, P = 0.88, χ2 test). At 1 month, thrombus burden, defined as the mean thrombus area divided by the mean lumen area, was significantly smaller with DES than with BMS (median interquartile range (IQR), 1.2 (0.0, 1.0) vs 1.2 (0.0, 2.2), P = 0.04, Mann‐Whitney U test), despite a similar percentage of malapposed (median (IQR), 6.2 (2.4, 9.0) vs 2.6 (0.0, 5.8)%, P = 0.07, Mann‐Whitney U test) or uncovered struts (median (IQR), 6.8 (1.8, 13.1) vs 6.14 (2.8, 18.5)%, P = 0.45, Mann‐Whitney U test). No significant difference in thrombus burden was observed between EES and ZES. Conclusions Thrombus burden was significantly smaller with DES than with BMS at 1‐month follow‐up in STEMI cases, although the percentage of malapposed or uncovered struts was similar between the groups. This may partly explain the lower rate of acute and subacute stent thrombosis in G2‐DES that has previously been reported in the literature.
No takes yet. Share an insight, caveat, or question.
Sato et al. (2018) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=41). Second-generation drug-eluting stents (G2-DES) vs. Bare-metal stent (BMS) was evaluated on Thrombus burden at 1 month (mean thrombus area divided by mean lumen area) (p=0.04). Second-generation drug-eluting stents were associated with a significantly smaller thrombus burden at 1 month compared to bare-metal stents in STEMI patients (P=0.04).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: