The use of a biodegradable polymer drug-eluting stent (BP-DES) during percutaneous coronary intervention (PCI) was associated with better long-term outcomes compared with that of a second-generation durable polymer drug-eluting stent (DP-DES) for the treatment of patients with acute myocardial infarction (MI), according to study results published in JACC: Cardiovascular Interventions.
Most randomized trials comparing the 2 types of stents have been non-inferiority trials that have not shown clinical superiority and there is little information available regarding long-term comparisons between these 2 options in a real-world setting.
This is a secondary analysis of the Korea Acute Myocardial Infarction Registry-National Institutes of Health registry, a nationwide multicenter prospective trial of patients with acute MI conducted between November 2011 and December 2015. In this study, 10,443 participants were selected from 13,104 registry patients who had a PCI following an acute MI. In this cohort, 2261 patients received a BP-DES (21.7%; mean age, 63.0 years; 76.7% men), and 8182 received a DP-DES (78.3%; mean age, 64.0 years; 75.5% men). Another 1694 individuals were propensity score- (PS) matched with patients in each stent group.
The study’s primary outcome was major adverse cardiac events (MACE), which included all-cause mortality, recurrent MI, or any revascularization. Secondary outcomes included net adverse clinical events (NACE), which consisted of MACE plus heart failure (HF) readmission, and stroke or probable/definite stent thrombosis.
MACE occurred in 1492 patients (14.3%) and were found to occur less frequently in participants implanted with a BP-DES vs a DP-DES (entire cohort [“cohort”]: hazard ratio [HR], 0.845; 95% CI, 0.740-0.965; P =.013; PS-matched [“PS”]: HR, 0.669; 95% CI, 0.550-0.814; P =.011) during a median follow-up of 723 days.
The risks for all-cause mortality (cohort: HR, 0.831; 95% CI, 0.692-0.997; P =.047; PS: HR, 0.752; 95% CI, 0.495-0.931; P =.014), recurrent MI (cohort: HR, 0.662; 95% CI, 0.466-0.941; P =.021; PS: HR, 0.611; 95% CI, 0.427-0.898; P =.003), cardiac death (cohort: HR, 0.685; 95% CI, 0.542-0.865; P =.002; PS: HR, 0.613; 95% CI, 0.463-0.872; P =.035), and HF readmission (cohort: HR, 0.625; 95% CI, 0.447-0.875; P =.006; PS: HR, 0.584; 95% CI, 0.385-0.887; P =.012) were lower in patients who had received a BP-DES vs a DP-DES. The risk for NACE was also lower in patients receiving a BP-DES vs a DP-DES (cohort: HR, 0.829; 95% CI, 0.734-0.936; P =.003; PS: HR, 0.795; 95% CI, 0.654-0.917; P =.003).
These more positive outcomes in patients implanted with a BP-DESs vs a DP-DESs were still observed beyond 1 year of follow-up. No significant differences between the 2 stents were detected for stroke, revascularization, or stent thrombosis incidences.
Study limitations include a possible selection bias, potential unmeasured confounders, and the use of various stent brands, possibly mitigating generalizability.
“BP-DES should be considered extensively in PCI procedures for acute MI to achieve enhanced clinical benefit,” noted the authors. They recommended that larger studies with longer follow-up examine further DES comparisons, including among individual BP-DES types.
Choe JC, Cha KS, Lee JG, et al. Long-term outcomes of biodegradable versus second-generation durable polymer drug-eluting stent implantations for myocardial infarction. JACC Cardiovas Interv. 2020;13(1):97-111. doi:10.1016/j.jcin.2019.08.020