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Impact of Ultrathin Strut Biodegradable Polymer Sirolimus-Eluting Stents in Percutaneous Coronary Intervention for
Narumi Taninobu1, Shunsuke Kubo1, Satoki Oka1
1Department of Cardiology, Kurashiki Central Hospital.
Insights
Ultrathin strut biodegradable polymer sirolimus-eluting stents (BP-SES) significantly reduce target lesion revascularization in hemodialysis patients undergoing percutaneous coronary intervention compared to other drug-eluting stents.
Area of Science:
- Cardiology
- Interventional Cardiology
- Nephrology
Background:
- Hemodialysis (HD) patients undergoing percutaneous coronary intervention (PCI) face increased cardiovascular risks.
- The efficacy of ultrathin strut biodegradable polymer sirolimus-eluting stents (BP-SES) in this high-risk group remains under investigation.
Purpose of the Study:
- To evaluate the safety and effectiveness of ultrathin strut BP-SES compared to other drug-eluting stents (DES) in hemodialysis patients undergoing PCI.
Main Methods:
- A retrospective study of 162 hemodialysis patients (286 lesions) undergoing PCI between January 2018 and June 2022.
- Comparison of ultrathin strut BP-SES versus other DES regarding clinically driven target lesion revascularization (TLR) and target vessel failure (TVF).
Main Results:
- Clinically driven TLR at 2 years was significantly lower with ultrathin strut BP-SES (2.9%) versus other DES (17.3%, P=0.028).
- Clinically driven target vessel revascularization (TVR) was also significantly lower in the ultrathin strut BP-SES group (4.5% vs. 25.7%, P=0.027).
- Smaller late lumen loss was observed with ultrathin strut BP-SES (0.13±0.40 mm) compared to other DES (0.67±1.02 mm, P<0.001).
Conclusions:
- Ultrathin strut BP-SES demonstrate superior outcomes in reducing revascularization events in hemodialysis patients post-PCI.
- This suggests a potential benefit of ultrathin strut BP-SES for hemodialysis patients undergoing percutaneous coronary intervention.
Background:
Hemodialysis (HD) is associated with adverse cardiovascular events after percutaneous coronary intervention (PCI). Although the ultrathin strut biodegradable polymer sirolimus-eluting stent (ultrathin strut BP-SES) has had better results in patients undergoing PCI compared with other drug-eluting stents (DES), its usefulness in HD patients is unknown.
Methods And Results:
This study involved 286 lesions in 162 HD patients who underwent PCI with a DES between January 2018 and June 2022. The incidence of clinically driven target lesion revascularization (TLR), target vessel failure (TVF: cardiac death, target vessel MI and clinically driven target vessel revascularization [TVR]) was assessed. During a median 636 days, clinically driven TLR occurred in 32 lesions. Clinically driven TLR at 2 years was significantly lower in the ultrathin strut BP-SES group than in the other DES group (2.9% vs. 17.3%, log-rank P=0.028). TVF occurred in 43 patients. The cumulative incidence of TVF was not different between two groups; however, clinically driven TVR was significantly lower in patients treated with the ultrathin strut BP-SES than with other DES (4.5% vs. 25.7%, log-rank P=0.027). In the quantitative coronary angiography analysis, late lumen loss at follow-up was significantly smaller in the ultrathin strut BP-SES group (0.13±0.40 vs. 0.67±1.02 mm, P<0.001).
Conclusions:
In patients on HD undergoing PCI, the incidence of clinically driven TLR was significantly lower in ultrathin strut BP-SES compared to other DES.
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