Medical Reports & Studies

Biodegradable vs Durable Everolimus Polymer Stent

The aim of this study was to compare the efficacy and safety of a thin-strut, biodegradable-polymer everolimus-eluting stent (BP-EES; Synergy) and a thin-strut, durable-polymer everolimus-eluting stent (DP-EES; XIENCE) in an all-comers population.

For patients undergoing percutaneous coronary intervention, treatment with thin-strut biodegradable-polymer everolimus-eluting stent (BP-EES) may be noninferior to thin-strut durable-polymer everolimus-eluting stent (DP-EES) at 12 months, according to results published in JACC: Cardiovascular Interventions. There was, however, a notable higher rate of acute stent thrombosis with BP-EES. This increased thrombosis rate was not detected at 1 year.

The study included 7042 participants who underwent percutaneous coronary intervention between December 2012 and December 2016. Of these, 1343 were exclusively treated with BP-EES and 2527 were treated with DP-EES. The researchers performed propensity score matching to determine a final study population of 1041 matched participants. The primary endpoint was the device-oriented composite endpoints of cardiac death, target vessel myocardial infarction, and target lesion revascularization at 12 months.

The results indicated that device-oriented composite endpoints did not significantly differ between participants treated with BP-EES (7.8%) compared with DP-EES (7.1%; hazard ratio [HR], 1.12; 95% CI, 0.81-1.53; Psuperiority =.49).

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After comparing BP-EES outcomes with DP-EES outcomes, the researchers did not find significant differences in rates of cardiac death (3.0% vs 3.0%; P =.998), target vessel myocardial infarction (3.6% vs 3.1%; P =.534), and target lesion revascularization (3.0% vs 2.5%; P =.418).

Compared with the DP-EES group, the BP-EES group had a significantly higher rate of acute stent thrombosis (1.2% vs 0.3%; HR, 4.00; 95% CI, 1.13-14.19; P =.032); however, at 12 months, this difference was no longer significant (1.5% vs 0.9%; HR, 1.67; 95% CI, 0.73-3.82; P =.22).

The study included several limitations. Despite propensity matching, residual confounding cannot be excluded. The researchers also noted that the follow-up duration was limited to 12 months, and event capture was based on questionnaires and review of hospital databases, which could lead to underreporting of events.

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“Studies providing further mechanistic insights using optical coherence tomography and careful attention to optimization of antithrombotic treatment strategies are required,” the researchers wrote.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.




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