Five-year clinical outcomes and intracoronary imaging findings of the COMFORTABLE AMI trial: randomized comparison of biodegradable polymer-based biolimus-eluting stents with bare-metal stents in patients with acute ST-segment elevation myocardial infarction.

Räber, Lorenz; Yamaji, Kyohei; Kelbæk, Henning; Engstrøm, Thomas; Baumbach, Andreas; Roffi, Marco; von Birgelen, Clemens; Taniwaki, Masanori; Moschovitis, Aris; Zaugg, Serge; Ostojic, Miodrag; Pedrazzini, Giovanni; Karagiannis-Voules, Dimitrios-Alexios; Lüscher, Thomas F; Kornowski, Ran; Tüller, David; Vukcevic, Vladan; Heg, Dik; Windecker, Stephan (2019). Five-year clinical outcomes and intracoronary imaging findings of the COMFORTABLE AMI trial: randomized comparison of biodegradable polymer-based biolimus-eluting stents with bare-metal stents in patients with acute ST-segment elevation myocardial infarction. European Heart Journal, 40(24), pp. 1909-1919. Oxford University Press 10.1093/eurheartj/ehz074

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AIMS

The long-term outcomes of biolimus-eluting stents (BESs) with biodegradable polymer as compared with bare-metal stent (BMS) in patients with ST-segment elevation myocardial infarction (STEMI) remain unknown.

METHODS AND RESULTS

We performed a 5-year clinical follow-up of 1157 patients (BES: N = 575 and BMS: N = 582) included in the randomized COMFORTABLE AMI trial. Serial intracoronary imaging of stented segments using both intravascular ultrasound (IVUS) and optical coherence tomography performed at baseline and 13 months follow-up were analysed in 103 patients. At 5 years, BES reduced the risk of major adverse cardiac events [MACE; hazard ratio (HR) 0.56, 95% confidence interval (CI): 0.39-0.79, P = 0.001], driven by lower risks for target vessel-related reinfarction (HR 0.44, 95% CI: 0.22-0.87, P = 0.02) and ischaemia-driven target lesion revascularization (HR 0.41, 95% CI: 0.25-0.66, P < 0.001). Definite stent thrombosis (ST) was recorded in 2.2% and 3.9% (HR 0.57, 95% CI: 0.28-1.16, P = 0.12) with no differences in rates of very late definite ST (1.3% vs. 1.6%, P = 0.77). Optical coherence tomography showed no difference in the frequency of malapposed stent struts at follow-up (BES 0.08% vs. BMS 0.02%, P = 0.10). Uncovered stent struts were rarely observed but more frequent in BES (2.1% vs. 0.15%, P < 0.001). In the IVUS analysis, there was no positive remodelling in either group (external elastic membrane area change BES: -0.63 mm2, 95% CI: -1.44 to 0.39 vs. BMS -1.11 mm2, 95% CI: -2.27 to 0.04, P = 0.07).

CONCLUSION

Compared with BMS, the implantation of biodegradable polymer-coated BES resulted in a lower 5-year rate of MACE in patients with STEMI undergoing primary percutaneous coronary intervention. At 13 months, vascular healing in treated culprit lesions was almost complete irrespective of stent type.

CLINICAL TRIAL REGISTRATION

http://www.clinicaltrials.gov. Unique identifier: NCT00962416.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)
04 Faculty of Medicine > Pre-clinic Human Medicine > Department of Clinical Research (DCR)
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Kardiologie
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Kardiologie

UniBE Contributor:

Räber, Lorenz, Yamaji, Kyohei, Taniwaki, Masanori, Moschovitis, Aris, Zaugg, Serge, Karagiannis Voules, Alexios, Heg, Dierik Hans, Windecker, Stephan

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0195-668X

Publisher:

Oxford University Press

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

13 Mar 2019 13:30

Last Modified:

20 Feb 2024 14:16

Publisher DOI:

10.1093/eurheartj/ehz074

PubMed ID:

30851032

Uncontrolled Keywords:

Coronary artery disease Drug-eluting stent Restenosis ST-segment elevation myocardial infarction Stent Stent thrombosis

BORIS DOI:

10.7892/boris.127862

URI:

https://boris.unibe.ch/id/eprint/127862

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