Thinner strut stents in patients with small vessels
07 July 2022
A subgroup analysis of the BIO-RESORT trial has shown a “trend towards better outcomes” with thinner strut stents in patients with small vessels (<2,5mm) undergoing percutaneous coronary intervention (PCI).
This is according to Eline H Ploumen (Medisch Spectrum Twente, Enschede, The Netherlands), who presented the findings at EuroPCR (17–20 May, Paris, France).
Patients with smaller coronary target vessels are usually associated with a higher risk of target lesion revascularisation (TLR) following percutaneous coronary intervention (PCI). In this context, the BIO-RESORT subgroup analysis aimed to assess whether thinner struts lead to a lower adverse event risk and better patient outcomes.
The randomised trial analysed the five-year outcomes of coronary artery disease patients treated with three contemporary DES of varying strut-thickness—ultrathin (Orsiro), very thin (Synergy) and thin (Resolute Integrity) strut drug-eluting stents.
“Although we have not seen a statistically significant difference in five-year target lesion failure rate, our subgroup-analysis shows a trend towards better outcomes with thinner strut DES for patients with small vessels,” commented Ploumen on the results. “While percutaneous coronary intervention of small vessel lesions remains challenging, thinner strut DES are a good choice for the treatment of these lesions.”
Findings from the study showed that although patients treated with Orsiro DES were more often treated for a complex target lesion than patients with other DES (71.4% for Orsiro vs. 68.7% for Synergy and 63.3% for Resolute Integrity), and the results show favourable outcomes for Biotronik’s ultrathin strut DES, a press release issued by the company noted.
Target lesion failure (TLF) for Orsiro DES remains numerically lower at five years (10.5% for Orsiro vs. 11.1% for Synergy and 12.6% for Resolute Integrity), the study reported, also finding that TLR for Orsiro DES remains numerically lower at five years (4.4% for Orsiro vs. 4.7% for Synergy and 6.8%% for Resolute Integrity). Definite or probable stent thrombosis rate remains numerically lower for Orsiro DES at five years (1.0% for Orsiro vs. 1.7% for Synergy and 2.0% for Resolute Integrity).
The BIO-RESORT non-inferiority study included 3,514 all-comer patients and was designed to assess two biodegradable polymer stents against a durable polymer reference device in all-comers patients. At one-year, non-inferiority was established for Orsiro and Synergy against Resolute Integrity DES3. Last year, full-cohort five-year outcomes from the BIO-RESORT trial were presented at the Transcatheter Cardiovascular Therapeutics conference (TCT 2021; 4–6 November, Orlando, USA and virtual).