Abstract
BackgroundThere 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.MethodsIn 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.ResultsFrom 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.ConclusionIn 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 registrationClinicalTrials.gov Identifier: NCT03544294. Retrospectively registered June 1, 2018.
Highlights
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
In patients with bifurcations or ULM treated with ultrathin stents BP-DES seems to perform to DPDES: 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
Among patients treated for Left Main disease, the risk of MACE was similar for BP-DES and durable polymer stents (DP)-DES
Summary
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. The complexity of the bifurcation milieu is rooted into the unique flow patterns that characterized them, with local low and oscillatory endothelial shear stress along the lateral walls of the main vessel and of the side branch, whereas high endothelial shear stress develops at the carina This ultimatey leads to a prothrombotic and atherogenic flowpattern, and even after treatment with percutaneous coronary intervention (PCI), it may increase the failure rate wit need for subsequent revascularization on the target lesion (TLR) and an increased risk of stent thrombosis (ST) [4,5,6]. Regarding currently implanted second generation DES, both in the EVOLVE II trial and in a recent paper of Mennuni et al [8, 9], BP-DESs were shown to be safe and effective as compared to durable polymer, coronary bifurcations and LM were underrepresented (respectively about 4 and 15%) [10]
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