Differential Effects of Newer-Generation Ultrathin-Strut Versus Thicker-Strut Drug-Eluting Stents in Chronic and Acute Coronary Syndromes.

Autor:	Iglesias JF; Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland. Electronic address: Juanfernando.Iglesias@hcuge.ch., Degrauwe S; Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland., Cimci M; Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland., Chatelain Q; Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland., Roffi M; Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland., Windecker S; Department of Cardiology, Inselspital, University of Bern, Bern University Hospital, Bern, Switzerland., Pilgrim T; Department of Cardiology, Inselspital, University of Bern, Bern University Hospital, Bern, Switzerland.
Jazyk:	angličtina
Zdroj:	JACC. Cardiovascular interventions [JACC Cardiovasc Interv] 2021 Nov 22; Vol. 14 (22), pp. 2461-2473.
DOI:	10.1016/j.jcin.2021.09.028
Abstrakt:	Objectives: The authors sought to compare the differential effects of ultrathin-strut and thicker-strut drug-eluting stents (DES) in patients with chronic (CCS) versus acute (ACS) coronary syndromes. Background: Newest-generation ultrathin-strut DES reduce target lesion failure (TLF) compared with thicker-strut second-generation DES in patients undergoing percutaneous coronary intervention. Methods: PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched for randomized controlled trials comparing newer-generation ultrathin-strut (<70 μm) versus thicker-strut (≥70 μm) DES. Patients were divided based on baseline clinical presentation (CCS versus ACS). The primary endpoint was TLF, a composite of cardiac death, target vessel myocardial infarction, or clinically indicated target lesion revascularization (TLR). Results: A total of 22,766 patients from 16 randomized controlled trials were included, of which 9 trials reported TLF rates in ACS patients. At a mean follow-up of 12.2 months, the risk of TLF was lower among patients treated with ultrathin-strut compared with thicker-strut DES (risk ratio [RR]: 0.85; 95% CI: 0.75-0.95; P = 0.006). The difference was driven by a lower risk of clinically-indicated TLR (RR: 0.75; 95% CI: 0.63-0.89; P < 0.001) among patients treated with ultrathin-strut DES. The treatment effect was consistent between patients presenting with CCS and ACS (relative RR: 0.97; 95% CI: 0.73-1.31; P for interaction = 0.854). In patients with ST-segment elevation myocardial infarction, TLF risk was lower among those treated with ultrathin- compared with thicker-strut DES (RR: 0.74; 95% CI: 0.54-0.99; P = 0.049). Conclusions: Ultrathin-strut DES reduce the risk of TLF compared with thicker-strut second-generation DES in patients undergoing percutaneous coronary intervention, a difference caused by a lower risk of ischemia-driven TLR. The treatment effect was consistent among patients with CCS and ACS. Competing Interests: Funding Support and Author Disclosures Statistical support was provided by the Clinical Research Center, University of Geneva, and Geneva University Hospitals. Dr Iglesias has received research grants to the institution from Abbott Vascular, AstraZeneca, Biotronik, and Philips Volcano, outside the submitted work; has received speaker fees from AstraZeneca, Biotronik, Medtronic, Novartis, Philips Volcano, and Terumo, outside the submitted work; and has received and consultancy fees from Biotronik, Cardinal Health, Corflow Therapeutics, Medtronic, and Terumo, outside the submitted work. Dr Degrauwe has received institutional research grants from Abbott Vascular; has received institutional research grants, educational grants, and personal fees from Biotronik. Dr Roffi has received institutional research grants from Terumo, Boston Scientific, Medtronic, Abbott Vascular, and Biotronik outside the submitted work. Dr Pilgrim has received institutional research grants from Biotronik, Boston Scientific, and Edwards Lifesciences; has received speaker fees from Biotronik and Boston Scientific; and has received consultancy fees for HighLife SAS outside the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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