Newer-Generation Ultrathin Strut Drug-Eluting Stents Versus Older Second-Generation Thicker Strut Drug-Eluting Stents for Coronary Artery Disease

Abstract

-Contemporary second-generation drug-eluting stents (DES) have superior efficacy and safety compared with early generation stents in patients undergoing percutaneous coronary intervention (PCI), in part related to their thinner struts. Whether newer generation ultra-thin DES further improve clinical outcomes compared with older second-generation thicker strut DES is unknown. -We searched PUBMED, EMBASE, and CENTRAL for randomized clinical trials that compared newer generation ultra-thin strut DES (defined as strut thickness<70 microns) versus thicker strut second-generation DES and reported clinical outcomes. The primary outcome was target lesion failure (TLF) (composite of cardiovascular death, target vessel myocardial infarction (MI) or ischemia-driven target lesion revascularization (TLR)) evaluated at 1-year follow-up. Tests for subgroup effects based on the ultra-thin strut DES type and based on the comparator DES type were performed using meta-regression analysis. -We identified 10 trials that randomized 11,658 patients and evaluated 3 newer generation ultra-thin strut DES: Orsiro stent (60 μm), MiStent (64 μm) and BioMime (65 μm). When compared with thicker strut second-generation DES, newer generation ultra-thin strut DES were associated with a 16% reduction in TLF (RR=0.84; 95% CI 0.72-0.99) driven by less MI (RR=0.80; 95% CI 0.65-0.99). Ultra-thin strut DES were also associated with qualitatively lower rates of any stent thrombosis (RR=0.72; 95% CI 0.51-1.01). Tests for subgroup effects based on the ultra-thin strut DES type (P=0.58) and the comparator DES type (P=0.98) were not significant, suggesting consistent outcomes across the three ultra-thin strut DES and with the different DES comparators. -In patients undergoing PCI, newer generation ultra-thin strut DES further improve 1-year clinical outcomes compared with contemporary thicker strut second-generation DES.

Biodegradable polymer sirolimus-eluting stents versus durable polymer everolimus-eluting stents in patients with ST-segment elevation myocardial infarction (BIOSTEMI): a single-blind, prospective, randomised superiority trial

“…Ultrathin strut drug-eluting stents have been associated with a lower risk of target lesion failure and myocardial infarction compared with thin strut drug-eluting stents in a meta-analysis of randomised trials. 23 A reduction in strut thickness has been shown to mitigate inflammation, vessel injury, neointimal proliferation, and thrombus formation. 11,24,25 These findings are particularly relevant in the inflammatory milieu of acute STEMI and might explain the differences we observed in the incidence of target lesion failure and target lesion revascularisation in patients treated with biodegradable polymer sirolimus-eluting stents compared with those treated with durable polymer everolimus-eluting stents.…”

The REMEDEE trial: 5‐Year results on a novel combined sirolimus‐eluting and endothelial progenitor cells capturing stent

“…The study results have to be seen in the context of the evolution of stent technology, in particular in decreasing strut thickness. A recent meta‐analysis has shown that ultra‐thin strut DES (<70 μm) are associated with lower target‐lesion failure rates . It can be speculated that an anti CD‐34 antibody layer on an ultra‐thin strut DES could result in even faster endothelial strut coverage.…”

Efficacy and safety of single vs dual antiplatelet therapy in patients on anticoagulation undergoing percutaneous coronary intervention: A systematic review and meta‐analysis

“…This likely explains the association of lower risk of ST with TAT which has a longer duration of DAPT. Nevertheless, stent technology that has advanced over the years with thinner stent struts and new bioresorbable polymers that further reduce the prothrombotic milieu is more likely a contributing factor in our results and majority of included studies in our analysis utilized DES . However, such benefit was not observed in our analysis of RCTs.…”