BIO-RESORT: Ultrathin-strut DES beneficial in small vessels at 3 years
Patients with small coronary vessels had a lower rate of target lesion revascularization if they were implanted with an ultrathin-strut sirolimus-eluting stent compared with a thin-strut zotarolimus-eluting stent, according to new data from BIO-RESORT presented at EuroPCR.
As Cardiology Today’s Intervention previously reported, BIO-RESORT was a comparison between the ultrathin-strut biodegradable polymer SES (Orsiro, Biotronik), the thin-strut durable polymer ZES (Resolute Integrity, Medtronic) and a very thin-strut biodegradable polymer everolimus-eluting stent (Synergy, Boston Scientific).
Clemens von Birgelen, MD, PhD, FESC, director of the department of cardiology at Thoraxcentrum Twente and professor of cardiology at the University of Twente in the Netherlands, presented 3-year data, which were simultaneously published in JAMA Cardiology.
The analysis included 1,452 patients (mean age, 64 years; 70% men) who had at least one small-vessel lesion (reference vessel diameter < 2.5 cm) and available 3-year follow-up data.
“Small coronary vessel PCI has an increased adverse event risk but is performed in many patients,” von Birgelen said during his presentation. “Newer DES, such as ultrathin strut Orsiro and very thin strut Synergy, have substantially thinner struts than earlier DES. This may be particularly advantageous in small vessels, due to the greater relative impact of strut size on lumen obstruction.”
The primary outcome was target lesion failure, defined as cardiac death, target vessel MI or target lesion revascularization.
TLF at 3 years occurred in 7% of the SES group, 9.5% of the EES group and 10% of the ZES group (HR for SES vs. ZES = 0.68; 95% CI, 0.44-1.05; HR for EES vs. ZES = 0.93; 95% CI, 0.62-1.39), according to the researchers.
However, TLR at 3 years was lower in the SES group compared with the ZES group (2.1% vs. 5.3%; HR = 0.4; 95% CI, 0.2-0.81), driven by revascularizations after 1 year (1% vs. 3.7%; adjusted HR = 0.42; 95% CI, 0.2-0.85), von Birgelen said.
There was no difference in 3-year TLR between the EES group and the ZES group (HR = 0.74; 95% CI, 0.41-1.34).
Three-year rates of cardiac death, target vessel MI and stent thrombosis did not differ between the groups, according to the researchers.
“Our findings suggest a relation between the use of the ultrathin-strut Orsiro stent and a lower repeat target lesion revascularization risk in all-comer patients with small vessel lesions,” von Birgelen said during his presentation.
In an Editor’s Note published in JAMA Cardiology, Cardiology Today’s Intervention Editorial Board Member Ajay Kirtane, MD, SM, director of the NewYork-Presbyterian Hospital/Columbia University Cardiac Catheterization Laboratories, and Cardiology Today’s Intervention Associate Medical Editor Roxana Mehran, MD, professor of medicine and director of interventional cardiology research at Icahn School of Medicine at Mount Sinai, wrote that the study “supports the hypothesis that the comparative contribution of stent strut thickness may be greatest among vessels that are not adequately sized to tolerate thicker-stent struts with the greater degree of intimal hyperplasia that may result from these devices.”
“The data lend credence to a patient-specific and lesion-specific approach to device selection that is supported through the generation of randomized clinical evidence,” they wrote. – by Erik Swain
von Birgelen C, et al. EuroPCR 2019 hot line and trial update. Presented at: EuroPCR; May 21-24, 2019; Paris.
Disclosures: von Birgelen reports he received institutional research grants from Abbott Vascular, Biotronik, Boston Scientific and Medtronic. Please see the study for the other authors’ relevant financial disclosures. Kirtane reports he received institutional research grants from Abbott Vascular, Abiomed, Boston Scientific, Cardiovascular Systems Inc., CathWorks, Medtronic, Philips, ReCor Medical and Siemens. Mehran reports she received institutional research grants from Abbott Vascular, AstraZeneca, Bayer, Boston Scientific, Bristol-Myers Squibb, CSL Behring, Daiichi Sankyo, Orbus Neich and Sanofi, and consultant fees from Abbott Vascular, Medscape and Sanofi.