Outcomes of durable versus biodegradable polymer drug-eluting stents in patients with coronary artery disease

TL;DR

This study compares biodegradable and durable polymer drug-eluting stents in heart disease patients, finding similar safety but fewer repeat procedures with biodegradable ones.

Contribution

The study provides new evidence on the comparative safety and effectiveness of biodegradable versus durable polymer drug-eluting stents in coronary artery disease patients.

Findings

Biodegradable polymer DES showed similar 5-year MACE rates compared to durable polymer DES.

TLR rates were significantly lower with biodegradable polymer DES, especially in ACS-PCI patients.

No significant differences in MACE or TLR were observed in CCS PCI patients.

Abstract

Percutaneous coronary intervention (PCI) is among the most common cardiovascular procedures, but stents still pose risks of restenosis or thrombosis. Drug-eluting stents (DES) with polymer coatings have improved long-term outcomes.

This study evaluated whether the latest biodegradable polymer DES (BP-DES) offer improved safety over durable polymer DES (DP-DES).

Data were collected from a single-centre registry at the Medical University of Vienna, including patients who underwent PCI between 2015 and 2020. Patients were categorized by stent type and PCI indication (All Comer, CCS-PCI, ACS-PCI). The primary endpoint comprised of major adverse cardiac events (MACE), including target lesion revascularization (TLR), target vessel revascularization (TVR), stent thrombosis (ST), and all-cause death.

2118 patients were eligible for further analysis. 1232 patients (58.2%) received a DP-DES. In the all-comer cohort, 5-year MACE rates were 12% for BP-DES vs 14.5% for DP-DES. Multivariate analysis showed no significant difference in MACE for the use of BP-DES (OR 0.941, 95% CI 0.734–1.207, p = 0.631). However, TLR rates were significantly lower in patients treated with BP-DES (3.4% vs 6.8%, OR 0.567, 95% CI 0.372–0.865, p = 0.008), mainly driven by lower rates of TLR within the ACS PCI cohort (1.5% vs 4.9%, OR 0.364, 95% CI 0.158–0.841, p = 0.018). In CCS PCI patients, MACE and TLR rates demonstrated no significant differences.

BP-DES and DP-DES show a similar long-term safety profile regarding MACE. BP-DES demonstrate a lower risk of TLR in the all-comer cohort, driven by reduced rates in ACS-PCI patients.

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