Thinner-strut DES confer improved 1-year outcomes
Newer-generation ultrathin-strut drug-eluting stents improved 1-year clinical outcomes in patients undergoing PCI compared with contemporary thicker-strut second-generation DES, according to data published in Circulation.
“Compared to first-generation DES, contemporary second-generation DES have thinner struts and more biocompatible polymers, which reduce vascular injury and inflammation, and promote faster endothelialization, decreasing neointimal proliferation and thrombogenicity. Whether event-free survival can be further improved by further enhancements in stent design is uncertain. Compared with durable polymers, drug elution from bioresorbable polymers and polymer-free systems offer theoretical advantages that to date have not been shown to confer improved clinical outcomes,” Sripal Bangalore, MD, MHA, FACC, FAHA, FSCAI, associate professor of medicine, director of research of the cardiac catheterization laboratory and director of the Cardiovascular Outcomes Group in the Cardiovascular Clinical Research Center at NYU Langone Health, and colleagues wrote in the study background. “Similarly, outcomes with first-generation bioabsorbable scaffolds have been disappointing. Thus, clinical outcomes with contemporary second-generation DES, while outstanding, have plateaued and largely remained steady over the last decade.”
To understand whether new-generation ultrathin-strut DES further improve clinical outcomes compared with older second-generation thicker-strut DES, Bangalore, a member of the Cardiology Today Editorial Board, and colleagues conducted a systematic meta-analysis of 11,658 patients from 10 randomized trials that compared newer-generation ultrathin-strut DES (defined as strut thickness < 70 µm) vs. thicker-strut second-generation DES and reported clinical outcomes.
The primary outcome of the meta-analysis was target lesion failure, defined as a composite of CV death, target vessel MI or ischemia-driven target lesion revascularization, evaluated at 1-year follow-up.
Other outcomes included the individual endpoints of CV death, MI, TLR and stent thrombosis.
The researchers found that newer-generation ultrathin-strut DES were associated with a 16% reduction in TLF (RR = 0.84; 95% CI, 0.72-0.99), driven by less MI (RR = 0.8; 95% CI, 0.65-0.99), compared with thicker-strut second-generation DES.
There was a trend toward lower rates of any stent thrombosis with the newer-generation ultrathin-strut DES (RR = 0.72; 95% CI, 0.51-1.01).
Although the researchers ran tests for subgroup effects based on the ultra-thin strut DES type and the comparator DES type, the results were not significant. According to the study, this suggests consistent outcomes across the three ultrathin-strut DES and with the different DES comparators.
“Data from this meta-analysis of randomized trials indicate that newer-generation ultrathin-strut DES further improve 1-year clinical outcomes compared with contemporary thicker-strut second-generation DES,” the researchers wrote. “Ultrathin-strut DES reduce the risk of target lesion failure driven by a reduction in myocardial infarction and also a lower rate of stent thrombosis when compared with contemporary thicker-strut second-generation DES.” – by Dave Quaile
Disclosures: Bangalore reports he has received grants from Abbott Vascular and the NHLBI; has been on the advisory boards of Abbott Vascular, Amgen, AstraZeneca, Boehringer Ingelheim, Daiichi Sankyo, Menarini, Pfizer and The Medicines Company; has been a consultant for Abbott Vascular and Merck; and has served as a consultant or adviser for Gilead. Please see the study for all other authors’ relevant financial disclosures.