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

Coronary interventions

Angiographic and clinical outcomes of STEMI patients treated with bioresorbable or metallic everolimus-eluting stents: a pooled analysis of individual patient data

EuroIntervention 2020;15:1451-1457. DOI: 10.4244/EIJ-D-18-01080

1. Deutsches Herzzentrum Munchen, Technische Universität München, Munich, Germany; 2. Amsterdam University Medical Centre, Amsterdam, the Netherlands; 3. DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany; 4. Hospital Clinic, Institut Clinic Cardiovascular, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; 5. Department of Cardiology, 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. Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands; 11. Clinic and Policlinic Internal Medicine I (Cardiology and Angiology), Klinikum rechts der Isar, Technische Universität München, Munich, Germany; 12. NHLI, Imperial College London, London, United Kingdom

Aims: Bioresorbable scaffolds (BRS) were conceived to ensure transient coronary artery support during antiproliferative drug delivery. However, the Absorb everolimus-eluting bioresorbable scaffold was found to be 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 the individual patient data of two randomised trials specifically designed to investigate the performance of Absorb versus EES in patients with acute myocardial infarction (MI). The primary outcome was lesion (in-segment) 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 revascularisation at one year. A total of 388 patients with STEMI were allocated to Absorb (n=227) or EES (n=161). Angiographic follow-up at one 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 –0.8%, 95% confidence interval [CI]: –3.18-1.48, p=0.47). DOCE occurred in 21 patients at one year, with similar distribution between the Absorb and EES groups (5.3% versus 5.6%; hazard ratio 0.95, 95% CI: 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 revascularisation. The long-term durability of Absorb and the extent to which newer BRS platforms might have a potential role in STEMI deserve further investigation. Both trials were registered at www.clinicaltrials.gov (NCT01942070 and NCT01986803).

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