Side branch occlusion with everolimus-eluting and paclitaxel-eluting stents: three-year results from the SPIRIT III randomised trial

Abstract

A total of 2,048 side branches were evaluated (EES N=1,345 side branches in 688 stented lesions, PES N=703 side branches in 346 stented lesions). Patients with compared to those without transient or final side branch occlusion had significantly higher non-Q-wave MI (NQMI) rates in-hospital (9.0% vs. 0.5%, p<0.0001). By multivariable analysis side branch occlusion was an independent predictor of NQMI (OR 4.45; 95% CI [1.82, 10.85]). Transient or final side branch occlusion occurred less frequently in patients receiving EES compared to PES (2.8% vs. 5.2%, p=0.009), contributing to the numerically lower rates of in-hospital NQMI with EES arm compared to PES (0.7% vs. 2.3%, p=0.05). Patients treated with EES rather than PES were less likely to develop side branch occlusion during stent placement, contributing to lower rates of periprocedural MI with EES compared to PES.

Impact of Strut Width in Periprocedural Myocardial Infarction

“…(14,15). Moreover, the wider struts of BRS may lead to a higher prevalence of side branch occlusion and periprocedural myocardial infarction (PMI) (17,18). DES with thicker struts have been associated with more angiographic and clinical restenosis than the thinnerstrut stents have, especially when treating small coronary vessels (16).…”

“…In the bare-metal stent era, although bare-metal stents reduced acute major complications, a paradoxical increase in the incidence of PMI was reported after stent implantation compared with that of balloon angioplasty (27). In the early DES era, the greater strut thickness of the first-generation DES had been implicated in a higher incidence of side branch occlusion and PMI than had the second-generation DES with thinner struts (17,18). With the advent of BRS, a main concern was the higher incidence of postprocedural side branch occlusion compared with that of second-generation DES (22).…”

Impact of overlapping newer generation drug-eluting stents on clinical and angiographic outcomes: pooled analysis of five trials from the international Global RESOLUTE Program

“…The mechanism is likely to be related to the increased strut thickness of the PES (approximately 148 μm), whereas the thinner strut R-ZES or EES were not associated with any increase risk of peri-procedural MACE or MI 45 46. This phenomenon has also been reported with the thicker strut bioresorbable scaffold, where a higher incidence of post-procedural small side branch occlusion was reported, compared to the Xience V EES 47…”

“…Fourth, that first generation DES—namely PES—have previously been demonstrated to be an independent predictor of small side branch occlusion in two post hoc angiographic studies comparing PES implantation to the thinner strut ZES (previous generation to the R-ZES) and EES 45 46. The mechanism is likely to be related to the increased strut thickness of the PES (approximately 148 μm), whereas the thinner strut R-ZES or EES were not associated with any increase risk of peri-procedural MACE or MI 45 46.…”

Everolimus-eluting stents in interventional cardiology

“…68 In a review of patients treated with an everolimus-eluting stent (n = 669) or a paclitaxel-eluting stent (n = 333) as part of the SPIRIT III trial, transient or final side branch occlusion occurred less frequently in those with an everolimus- eluting stent than in those who had a paclitaxel-eluting stent (2.8% versus 5.2%; P = 0.009) 69…”