Newer-Generation Ultra-Thin DES Compared to Older-Generation Thicker-Strut DES

June 29, 2018—Findings from a meta-analysis of randomized trials comparing newer-generation ultra-thin-strut drug-eluting stents (DES) versus older second-generation thicker-strut DESs for percutaneous coronary intervention (PCI) to treat coronary artery disease were published by Sripal Bangalore, MD, et al online ahead of print in Circulation.

The investigators concluded that in patients undergoing PCI, newer-generation ultra-thin DESs further improved 1-year clinical outcomes compared with contemporary thicker second-generation DESs.

The background of the study is that contemporary second-generation DESs have superior efficacy and safety compared with early-generation stents in patients undergoing PCI, related in part to their thinner struts. The study sought to find whether newer-generation ultra-thin DESs further improved clinical outcomes compared with older second-generation thicker DESs.

As summarized in Circulation, the investigators searched Pubmed, Embase, and Central databases for randomized clinical trials that compared newer-generation ultra-thin strut DESs (defined as strut thickness < 70 μm) versus thicker-strut second-generation DESs and reported clinical outcomes.

The primary outcome was target lesion failure ([TLF] a composite of cardiovascular death, target vessel myocardial infarction, or ischemia-driven target lesion revascularization) evaluated at 1-year follow-up. Tests for subgroup effects based on the ultra-thin-strut DESs type and based on the comparator DESs type were performed using meta-regression analysis.

The investigators identified 10 trials that randomized 11,658 patients and evaluated three newer-generation ultra-thin strut DESs: Orsiro stent (Biotronik; 60 μm), MiStent (Micell Technologies, Inc.; 64 μm), and BioMime (Meril Life Sciences Pvt. Ltd.; 65 μm).

When compared with thicker-strut second-generation DESs, newer-generation ultra-thin-strut DESs were associated with a 16% reduction in TLF (risk ratio [RR] = 0.84; 95% confidence interval [CI], 0.72–0.99) driven by less myocardial infarction (RR = .8; 95% CI, 0.65–0.99). Ultra-thin-strut DESs were also associated with qualitatively lower rates of any stent thrombosis (RR = 0.72; 95% CI, 0.51–1.01). Tests for subgroup effects based on the ultra-thin-strut DES type (P = .58) and the comparator DES type (P = .98) were not significant, suggesting consistent outcomes across the three ultra-thin-strut DESs and with the different DES comparators, reported the investigator in Circulation.