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Thin strut bare metal stents in patients with atrial fibrillation: Is there still a need for BMS?
Matthias Leschke1, Matthias Waliszewski2, Maxime Pons3
1Klinik für Kardiologie, Angiologie und Pneumologie, Klinikum Esslingen, Esslingen, Germany. m.leschke@klinikum-esslingen.de.
Insights
Thin strut bare metal stenting (BMS) in patients with atrial fibrillation (AF) shows comparable 9-month clinical outcomes to those without AF. This approach offers a shorter dual antiplatelet therapy (DAPT) duration, beneficial in a drug-eluting stent (DES)-dominant practice.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomedical Engineering
Background:
- Drug-eluting stents (DES) are standard for coronary artery disease (CAD).
- Bare metal stents (BMS) are indicated for patients unable to tolerate long dual antiplatelet therapy (DAPT).
- Thin strut BMS offer potential advantages in specific patient groups.
Purpose of the Study:
- To assess 9-month clinical outcomes of thin strut BMS in an 'all comers' population.
- To specifically evaluate outcomes in patients with atrial fibrillation (AF) undergoing BMS implantation.
- To compare outcomes between AF and non-AF patients post-BMS.
Main Methods:
- An international, multicenter, non-randomized observational study.
- Investigated thin strut BMS implantation in pre-defined subgroups.
- Primary endpoint: 9-month Target Lesion Revascularization (TLR) rate. Secondary endpoints: 9-month Major Adverse Cardiovascular Events (MACE) and procedural success.
Main Results:
- 783 patients received BMS, including 98 with AF. Mean age was 70.4 years.
- 9-month TLR rates were 4.5% (non-AF) vs. 3.3% (AF) (P=0.613).
- 9-month MACE rates were 10.7% (non-AF) vs. 6.7% (AF) (P=0.237), with similar stroke rates.
Conclusions:
- Thin strut BMS implantation in AF patients yields acceptable Target Lesion Revascularization (TLR) and Major Adverse Cardiovascular Events (MACE) rates.
- BMS offers a shorter DAPT duration, a significant advantage in current DES-dominated practice.
- This study supports BMS as a viable option for AF patients with DES contraindications.
Objectives:
This observational study assessed the 9-month clinical outcomes in an « all comers » population with a focus on patients with atrial fibrillation (AF) after thin strut bare metal stenting.
Background:
Drug eluting stent (DES) implantation is the treatment of choice for coronary artery disease (CAD) leaving only marginal indications for the use of bare metal stents (BMS). However, selected treatment populations with DES contraindications such as patients who cannot sustain 6-12 months of dual antiplatelet therapy (DAPT) remain candidates for BMS implantations.
Methods:
Thin strut bare metal stenting in a priori defined subgroups were investigated in a non-randomized, international, multicenter «all comers» observational study. Primary endpoint was the 9-month TLR rate whereas secondary endpoints included the 9-month MACE and procedural success rates.
Results:
A total of 783 patients of whom 98 patients had AF underwent BMS implantation. Patient age was 70.4 ± 12.8 years. Cardiovascular risk factors in the overall population were male gender (78.2%, 612/783), diabetes (25.2%, 197/783), hypertension (64.1%, 502/783), cardiogenic shock (4.9%, 38/783) and end stage renal disease (4.9%, 38/783). In-hospital MACE was 4.1% (30/783) in the overall population. The 9-month TLR rate was 4.5% (29/645) in the non-AF group and 3.3% (3/90) in the AF group (P = 0.613). At 9 months, the MACE rate in the AF-group and non-AF group was not significantly different either (10.7%, 69/645 vs. 6.7%, 6/90; P = 0.237). Accumulated stroke rates were 0.3% (2/645) in the non-AF subgroup at baseline and 1.1% (1/90) in the AF subgroup (P = 0.264).
Conclusion:
Bare metal stenting in AF patients delivered acceptably low TLR and MACE rates while having the benefit of a significantly shorter DAPT duration in a DES dominated clinical practice. © 2015 Wiley Periodicals, Inc.
