Multivessel PCI with thin-strut BP-SES outperforms DP-EES for STEMI

In patients with ST-segment elevation myocardial infarction (STEMI), multivessel percutaneous coronary intervention (PCI) with thin-strut biodegradable polymer sirolimus-eluting stents (BP-SES) results in better 2-year outcomes than durable polymer everolimus-eluting stents (DP-EES), a recent study has found.

Conducting a subgroup analysis of the BIOSTEMI* trial, the researchers enrolled 145 STEMI patients undergoing multivessel PCI. The primary endpoint of interest was target lesion failure (TLF), described as a composite of cardiac death, target vessel myocardial re-infarction, or clinically indicated target lesion revascularization.  

Of the participants, 72 received BP-SES, while 73 were given DP-EES. TLF occurred in 2.8 percent and 18.7 percent in the respective subgroups. In turn, the risk estimate for the primary outcome was significantly lower in the BP-SES subgroup (hazard ratio [HR], 0.14, 95 percent confidence interval [CI], 0.03–0.61; p=0.009).

However, each of the individual components of TVF were documented at comparable frequencies between the treatment arms: cardiac death (HR, 0.38, 95 percent CI, 0.07–1.97; p=0.250) and myocardial reinfarction (HR, 0.18, 95 percent CI, 0.02–1.57; p=0.121). Target lesion revascularization did not occur in the BP-SES group, so comparative risk analysis was impossible.

Target vessel revascularization, both clinically indicated (HR, 0.27, 95 percent CI, 0.07–0.99; p=0.048) or otherwise (HR, 0.24, 95 percent CI, 0.07–0.87; p=0.03), was less likely to occur in the BP-SES group, as was target vessel failure (HR, 0.28, 95 percent CI, 0.10–0.76; p=0.013).

“Overall, there was a borderline significant treatment interaction suggesting incremental clinical benefits with thin-strut BP-SES over DP-EES with respect to the 2-year TLF risk in patients with STEMI undergoing multivessel PCI,” the researchers said. “To the best of our knowledge, the present is the first study suggesting differential clinical outcomes between newer-generation drug-eluting stents.”