Outcomes of patients treated with a biodegradable-polymer sirolimus-eluting stent versus durable-polymer everolimus-eluting stents after rotational atherectomy

Clin Res Cardiol. 2021 Oct;110(10):1574-1585. doi: 10.1007/s00392-021-01852-9. Epub 2021 Apr 16.

Abstract

Objective: To compare Orsiro biodegradable-polymer sirolimus-eluting stent (Orsiro BP-SES) with durable-polymer everolimus-eluting stent (DP-EES) regarding target lesion failure (TLF) after rotational atherectomy (RA), with a focus on small stents (diameter ≤ 3 mm) where Orsiro BP-SES has 60 µm strut thickness, while DP-EES remains with 81 µm strut thickness.

Background: New-generation drug-eluting stent (DES) is superior to early-generation DES in all percutaneous coronary intervention (PCI) settings including RA. Recently, the Orsiro BP-SES was superior to a DP-EES in an all comer's population.

Methods: Among patients who underwent RA at a single center, 121 were treated with Orsiro BP-SES and 164 with DP-EES (Promus and Xience). Those treated with other stent types, presenting with acute myocardial infarction or had a chronic total occlusion were excluded. Incidence of TLF was assessed.

Results: After 2 years, the TLF rate in Orsiro BP-SES and DP-EES groups was 10% and 18%, respectively (adjusted HR 0.55, 95%CI 0.26-1.16, p = 0.115). The rate of TLF was significantly lower in small Orsiro BP-SES with ultra-thin struts as compared to DP-EES with the same diameters (adjusted HR 0.19, 95% CI 0.04-0.87, p = 0.032), driven by lower rates of clinically driven target lesion revascularization (log-rank p = 0.022). Age (p = 0.035), total stent length (p = 0.007) and diabetes mellitus (p = 0.011) emerged as independent predictors of TLF in the whole population.

Conclusion: In the whole cohort, Orsiro BP-SES and DP-EES had comparable rates of long-term TLF after RA. In the small stent subgroup, the Orsiro BP-SES with ultra-thin struts showed significant lower rate of TLF at 2 years.

Keywords: Biodegradable-polymer; Coronary calcification; Rotational atherectomy; Ultra-thin struts.

Publication types

  • Comparative Study

MeSH terms

  • Absorbable Implants
  • Aged
  • Atherectomy, Coronary / methods*
  • Coronary Artery Disease / surgery
  • Drug-Eluting Stents*
  • Everolimus / administration & dosage*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Polymers / chemistry
  • Prosthesis Design
  • Retrospective Studies
  • Sirolimus / administration & dosage*
  • Treatment Failure
  • Treatment Outcome

Substances

  • Polymers
  • Everolimus
  • Sirolimus