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

• Published in: Clinical research in cardiology Vol. 110; no. 10; pp. 1574 - 1585
• Main Authors: Mankerious, Nader, Hemetsberger, Rayyan, Traboulsi, Hussein, Toelg, Ralph, Abdel-Wahab, Mohamed, Richardt, Gert, Allali, Abdelhakim
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2021; Springer Nature B.V
• Subjects: Absorbable Implants; Aged; Atherectomy, Coronary - methods; Biodegradability; Biodegradation; Cardiology; Coronary Artery Disease - surgery; Diabetes mellitus; Diameters; Drug delivery; Drug-Eluting Stents; Everolimus - administration & dosage; Female; Follow-Up Studies; Humans; Implants; Lesions; Male; Medicine; Medicine & Public Health; Myocardial infarction; Occlusion; Original Paper; Polymers; Polymers - chemistry; Prosthesis Design; Rapamycin; Retrospective Studies; Sirolimus - administration & dosage; Stents; Struts; Subgroups; Thickness; Treatment Failure; Treatment Outcome; Coronary calcification; Rotational atherectomy; Biodegradable-polymer; Ultra-thin struts
• ISSN: 1861-0684; 1861-0692
• DOI: 10.1007/s00392-021-01852-9

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. Graphic abstract