The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Angiographic and clinical outcomes of STEMI patients treated with bioresorbable or metallic everolimus-eluting stents. A pooled analysis of individual patient data from 2 randomized trials

EuroIntervention 2019; just accepted article published in February 2019. DOI: 10.4244/EIJ-D-18-01080

1. Deutsches Herzzentrum Munchen, Technische Universität München, Munich, Germany, GERMANY; 2. Amsterdam University Medical Centre, Amsterdam, the Netherlands; 3. Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; 4. Hospital Clinic, Institut Clinic Cardiovascular, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; 5. Cardiac Department, Hospital Universitario de La Princesa Madrid, Madrid, Spain; 6. Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; 7. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; 8. Complejo Hospitalario Universitario, Hospital Alvaro Cunqueiro, Vigo, Spain; 9. E.N. Meshalkin National Medical Research Center, Novosibirsk, Russia; 10. ThoraxCentre, Erasmus Medical Centre, Rotterdam, the Netherlands; 11. Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; 12. Hospital Clinic, Institut Clinic Cardiovascular, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; 13. DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany; 14. Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; 15. Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; 16. NHLI, Imperial College London, London, United Kingdom
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Aims: Bioresorbable scaffolds (BRS) were conceived to ensure transient coronary artery support during antiproliferative drug delivery. However, the everolimus-eluting bioresorbable scaffold Absorb (Abbott Vascular, Santa Clara, CA, USA) was found inferior to everolimus-eluting metallic stents (EES) in moderately complex coronary anatomies. We sought to investigate whether the Absorb represents a valuable option for the percutaneous treatment of patients with ST-elevation myocardial infarction (STEMI).

Methods and results: We pooled individual patient data of two randomized trials designed to investigate the performance of Absorb versus EES in patients with acute myocardial infarction (MI). The primary outcome was lesion diameter stenosis at angiographic follow-up. The main secondary outcome was the device-oriented composite endpoint (DOCE) of cardiac death, target vessel MI and target lesion revascularization at 1 year. A total of 388 patients with STEMI were allocated to Absorb (n=227) or EES (n=161). Angiographic follow-up at 1 year was available for 332 (85.6%) patients. Lesion diameter stenosis was comparable between Absorb and EES (22.8±9.8% versus 23.6±11.2%; mean difference, 95% Confidence intervals= -0.8% [-3.18, 1.48], P= 0.47). DOCE occurred in 21 patients at 1 year, with similar distribution between Absorb and EES groups (5.3% versus 5.6%; hazard ratio, 95% Confidence intervals= 0.95 [0.40, 2.26], P= 0.91).

Conclusions: This pooled analysis provides evidence for a comparable angiographic performance and suggests similar clinical performance of Absorb and EES in STEMI patients undergoing percutaneous revascularization. The long-term durability of Absorb and the extent to which newer BRS platforms might have a potential role in STEMI deserve further investigation.

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