Key result
Self-apposing stents linked to higher 4-year TLR risk vs balloon-expandable stents.
Why the study?
Data suggest that different stent platforms can impact outcomes after left main PCI, prompting a comparison of 4-year outcomes between balloon-expandable and self-apposing stents.
Does PCI with self-apposing stents compared to balloon-expandable stents improve 4-year outcomes in patients with left main stenosis?
Cohort (n=146)
No
Does PCI with self-apposing stents compared to balloon-expandable stents improve 4-year outcomes in patients with left main stenosis?
Hazard Ratio: 0.06 (95% CI 1.11–11.7)
p-value: p=0.03
In patients undergoing left main PCI, self-apposing stents were associated with a significantly higher rate of target lesion revascularization at 4 years compared to balloon-expandable stents.
Self-apposing stents were associated with higher TLR after left main PCI; hypothesis-generating and should not change practice pending RCTs.
Background Left main percutaneous coronary intervention (PCI) has been established as an effective and safe treatment option for left main coronary artery disease. There are data suggesting that different stent platforms can impact the outcomes after left main PCI. The aim of current study was to compare the four-year outcomes of patients with left main stenosis treated by PCI with a balloon-expandable stent or a self-apposing stent. Methods and Results A total of 146 patients with left main stenosis treated by PCI were included, of which 84 (57.5%) had balloon-expandable stents (Group A) and 62 (42.5%) had self-apposing stents (Group B). Baseline SYNTAX scores were higher in Group A than in Group B. Proximal optimization technique was used more often in Group A (45.2% in Group B vs 81.4% in Group A, p<0.001). The same observations were made for kissing balloon postdilation (30.6% Group B vs 62.7% in Group A, p<0.001). Procedural success with TIMI 3 flow was achieved in similar proportions in both groups. Mortality rate and MACE rates at 4-year follow-up were higher in Group B compared to Group A but have not reached statistical significance in univariable or multivariable analysis. Implantation of a self-apposing stent has been an independent predictor for target lesion revascularization rate (TLR) in multivariable analysis (HR 0.06, CI − 1.11–11.7, =0.03). Conclusions In our study, TLR rate was significantly higher in patients with left main lesion treated by PCI with self-apposing stents.
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Predescu et al. (2022) conducted a cohort in Unprotected left main coronary artery disease (n=146). Self-apposing stents vs. Balloon-expandable stents was evaluated on Target lesion revascularization (TLR) at 4 years (HR 0.06, 95% CI 1.11-11.7, p=0.03). Implantation of a self-apposing stent was an independent predictor for a significantly higher target lesion revascularization rate at 4 years compared to balloon-expandable stents (HR 0.06).
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