Twelve‐month outcomes of patients unsuitable for prolonged DAPT presenting with an acute coronary syndrome and treated with polymer‐free biolimus A9 drug‐coated stents. Issue 7 (23rd September 2018)

• Record Type: Journal Article
• Authors: Kinnaird, Tim; Abdul, Fairoz; Hailan, Ahmed; Sheikh, Azeem; Hinton, Jonathan; Yazji, Khaled; Elangovan, Senthil; Yousef, Adnan; Gallagher, Sean; Choudhury, Anirban; Anderson, Richard; O'Kane, Peter; Smith, David
• Is Part Of: Catheterization and cardiovascular interventions. Volume 92:Issue 7(2018)
• Page Start: 1220
• Page End: 1228
• Publication Date: 2018-09-23
• Subjects: biolimus A9 drug‐coated stent -- DAPT duration -- high‐bleeding risk; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.27722
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract: Introduction: Prolonged dual anti‐platelet therapy (DAPT) is undesirable in certain patients. The biolimus‐A9 drug‐coated stent (BA9‐DCS) has a rapid drug‐elution profile allowing shortened DAPT. Methods: The demographics, procedural data, and clinical outcomes for 505 patients presenting with an ACS to three UK centres and treated with a BA9‐DCS stent (PCI‐DCS) were collected, and compared to a consecutive ACS cohort of unselected patients treated in the same period with drug‐eluting stents (PCI‐DES). Results: PCI‐DCS patients were older, more often female with hypertension, chronic kidney disease, severe LV dysfunction, and peripheral vascular disease more frequent than the PCI‐DES cohort. PCI‐DCS patients had a much higher Mehran bleed risk score (21.5 ± 7.7 vs. 15.9 ± 7.7, P < 0.0001). Baseline disease burden was greater in the PCI‐DCS cohort with more left main and three vessel disease. During PCI, more stents (1.91 ± 1.1 vs. 1.57 ± 0.94, P < 0.0001), total stent length (38.2 ± 20.8 vs. 31.4 ± 20.3, P < 0.0001) and longer stents (38.2 ± 20.8 vs. 31.4 ± 20.3 mm, P < 0.0001) were used in the PCI‐DCS cohort with rotational atherectomy also used more frequently. Physician‐recommended DAPT duration was 2.9 ± 3.9 months for PCI‐DCS patients and 11.3 ± 2.4 months for PCI‐DES patients ( P < 0.0001). At 12‐month follow‐up, definite stent thrombosis (0.6% vs. 1.1%) and TLR (3.2% vs. 2.7%) rates were similar between the two groups. After adjustment for baseline differences, there were no statistically significant differences in death and combined MACE rates at 12 months. Conclusions: The outcomes of patients treated with polymer‐free BA9 drug‐coated stent who present with an ACS and who were deemed unsuitable for prolonged DAPT are encouraging. Further studies are warranted.