Iglesias, Juan F; Degrauwe, Sophie; Cimci, Murat; Chatelain, Quentin; Roffi, Marco; Windecker, Stephan; Pilgrim, Thomas (2021). Differential Effects of Newer-Generation Ultrathin-Strut Versus Thicker-Strut Drug-Eluting Stents in Chronic and Acute Coronary Syndromes. JACC. Cardiovascular Interventions, 14(22), pp. 2461-2473. Elsevier 10.1016/j.jcin.2021.09.028
|
Text
Differential.pdf - Published Version Available under License Creative Commons: Attribution-Noncommercial-No Derivative Works (CC-BY-NC-ND). Download (2MB) | Preview |
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.
Item Type: |
Journal Article (Original Article) |
|---|---|
Division/Institute: |
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology |
UniBE Contributor: |
Windecker, Stephan, Pilgrim, Thomas |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
1876-7605 |
Publisher: |
Elsevier |
Language: |
English |
Submitter: |
Nadia Biscozzo |
Date Deposited: |
20 Jan 2022 08:54 |
Last Modified: |
05 Dec 2022 15:59 |
Publisher DOI: |
10.1016/j.jcin.2021.09.028 |
PubMed ID: |
34794652 |
Uncontrolled Keywords: |
acute coronary syndrome drug-eluting stent(s) percutaneous coronary intervention ultrathin-strut |
BORIS DOI: |
10.48350/163180 |
URI: |
https://boris.unibe.ch/id/eprint/163180 |
Actions (login required)
 |
Edit item |