Impact of thinner strut design on current generation drug-eluting stent in all-comers

Since their creation in 2002, drug-eluting stents (DES) have proven their superiority over their bare-metal counterparts and significantly evolved. Efforts are now concentrated on improving the DES platform, particularly by integrating thinner stent design. We aimed to compare outcomes between a broad range of current generation DES to evaluate the impact of thinner strut design in a real-world setting.

We analysed data from 3092 patients who underwent percutaneous coronary intervention (PCI) with thin (≤80 μm) or thick (>80 μm) DES in the Cardio-FR database. Of these, 2551 (1567 thick DES and 984 thin DES) met the inclusion and exclusion criteria and completed a two-year follow-up: The primary outcome was the device-oriented composite endpoint (DOCE) of cardiac death, non-fatal target vessel myocardial infarction (TVMI) and target lesion revascularization (TLR).

The mean age was 67 years, and 75% were male. After multivariable adjustment, thick-strut DES were associated with higher 2-year DOCE compared with thin-strut DES (adjusted OR for thick vs thin: 1.298; 95% CI: 1.006-1.674; p = 0.045). In contrast, stroke was less frequent with thick-strut DES (2.0% vs 3.4%; p = 0.041). All other event rates were similar between the groups.

Clinical follow-up up to two years shows treatment with thin strut DES significantly lowers DOCE rates compared with thick strut DES. More research is needed to assess the impact of thinner strut design on performance.