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Updated: Aug 2, 2025
A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Patients with higher-atherothrombotic risk vs. lower-atherothrombotic risk undergoing coronary intervention with
Rayyan Hemetsberger1, Nader Mankerious2, Ralph Toelg2
1Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. rayyan.hemetsberger@hotmail.com.
Insights
Patients with higher atherothrombotic risk (H-ATR) face increased ischemic events. Bioresorbable-polymer sirolimus-eluting stents (BP-SES) showed lower target lesion failure (TLF) rates compared to durable-polymer everolimus-eluting stents (DP-EES), especially in lower-risk patients.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomaterials in Medical Devices
Background:
- Atherothrombotic disease poses significant ischemic event risk, necessitating effective preventive strategies.
- The comparative efficacy of bioresorbable-polymer sirolimus-eluting stents (BP-SES) versus durable-polymer everolimus-eluting stents (DP-EES) in high-atherothrombotic-risk patients remains incompletely understood.
- Percutaneous coronary intervention (PCI) outcomes may differ based on stent type and patient atherothrombotic risk stratification.
Purpose of the Study:
- To compare the clinical outcomes of BP-SES versus DP-EES in patients undergoing PCI.
- To evaluate outcomes stratified by higher atherothrombotic risk (H-ATR) versus lower atherothrombotic risk (L-ATR).
- To assess the incidence of target lesion failure (TLF) and stent thrombosis (ST) at three years.
Main Methods:
- Analysis of 2361 patients from BIOFLOW-II, -IV, and -V randomized trials.
- Patients categorized into H-ATR (≥2 risk factors) and L-ATR (≤1 risk factor) based on clinical presentation and history.
- Primary endpoints included TLF (cardiac death, TV-MI, TLR) and ST, assessed at three years post-PCI.
Main Results:
- H-ATR patients exhibited significantly higher TLF rates compared to L-ATR patients (11.6% vs. 7.0%).
- BP-SES demonstrated numerically lower TLF rates than DP-EES in H-ATR patients (10.5% vs. 13.5%).
- BP-SES showed significantly lower TLF rates compared to DP-EES in L-ATR patients (5.6% vs. 9.8%).
Conclusions:
- Even with modern drug-eluting stents, H-ATR patients remain at elevated risk for ischemic events.
- BP-SES use was associated with lower TLF rates compared to DP-EES, particularly in L-ATR patients.
- For H-ATR patients, secondary preventive strategies may be crucial alongside stent choice for optimal outcomes.
Background:
Patients with atherothrombotic risk are at high hazard of ischemic events. Preventive medicine plays a major role in modifying their outcomes. Whether the choice of a BP-SES or DP-EES can contribute to the occurrence of events remains unclear. We sought to investigate the outcomes of patients with higher atherothrombotic risk (H-ATR) versus lower atherothrombotic risk (L-ATR) undergoing percutaneous coronary intervention (PCI) with either bioresorbable-polymer sirolimus-eluting stent (BP-SES) or durable-polymer everolimus-eluting stent (DP-EES).
Methods:
Patients (n = 2361) from BIOFLOW-II, -IV, and -V randomized trials were categorized into H-ATR vs. L-ATR. L-ATR patients had ≤ 1 and H-ATR ≥ 2 of the following criteria: presentation in ACS, diabetes mellitus, previous myocardial infarction, previous PCI/CABG, or previous stroke. Endpoints were target lesion failure (TLF: cardiac death, target-vessel myocardial infarction [TV-MI], target lesion revascularization [TLR]) and stent thrombosis (ST) at three years.
Results:
H-ATR patients (n = 1023) were more morbid than L-ATR patients (n = 1338). TLF rate was significantly higher in H-ATR patients as compared with L-ATR (11.6% vs. 7.0%; HR 1.67, 95% CI 1.27-2.20, p < 0.0001). With BP-SES TLF rates were numerically lower as compared with DP-EES in H-ATR (10.5% vs. 13.5%; HR 0.78, 95% CI 0.54-1.14, p = 0.20) and significantly lower in L-ATR (5.6% vs. 9.8%; HR 0.57, 95% CI 0.38-0.85, p = 0.006).
Conclusion:
In the era of newer-generation DES, patients with H-ATR still are at hazard for ischemic events. Patients with BP-SES had lower TLF rates as compared with DP-EES, most consistent in L-ATR whereas in H-ATR patients most probably secondary preventive strategies are of higher value.
Clinical Trial Registration:
Clinicaltrial.gov. NCT01356888, NCT01939249, NCT02389946. https://clinicaltrials.gov/show/NCT01356888 , https://clinicaltrials.gov/show/NCT01939249 , https://clinicaltrials.gov/show/NCT02389946 .
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