Impact of structural features of very thin stents implanted in unprotected left main or coronary bifurcations on clinical outcomes. Issue 1 (20th December 2019)

• Record Type: Journal Article
• Authors: Iannaccone, Mario; D'Ascenzo, Fabrizio; Gallone, Guglielmo; Mitomo, Satoru; Parma, Radosław; Trabattoni, Daniela; Ryan, Nicola; Muscoli, Saverio; Venuti, Giuseppe; Montabone, Andrea; De Lio, Francesca; Zaccaro, Lorenzo; Quadri, Giorgio; De Filippo, Ovidio; Wojakowski, Wojciech; Rognoni, Andrea; Helft, Gerard; Gallo, Diego; De Luca, Leonardo; Figini, Filippo; Imori, Yoichi; Conrotto, Federico; Boccuzzi, Giacomo; Mattesini, Alessio; Wańha, Wojciech; Smolka, Grzegorz; Huczek, Zenon; Rolfo, Cristina; Pennone, Mauro; Cortese, Bernardo; Capodanno, Davide; Chieffo, Alaide; Nuñez‐Gil, Ivan; Morbiducci, Umberto; D'Amico, Maurizio; Varbella, Ferdinando; Romeo, Francesco; Sheiban, Imad; Escaned, Javier; Garbo, Roberto; Moretti, Claudio; di Mario, Carlo; De Ferrari, Gaetano M.;
• Is Part Of: Catheterization and cardiovascular interventions. Volume 96:Issue 1(2020)
• Page Start: 1
• Page End: 9
• Publication Date: 2019-12-20
• Subjects: Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.28667
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract: Objectives: To evaluate the independent clinical impact of stent structural features in a large cohort of patients undergoing unprotected left main (ULM) or coronary bifurcation percutaneous coronary intervention (PCI) with a range of very thin strut stents. Background: Clinical impact of structural features of contemporary stents remains to be defined. Methods: All consecutive patients enrolled in the veRy thin stents for patients with left mAIn or bifurcatioN in real life (RAIN) registry were included. The following stent structural features were studied: antiproliferative drugs (everolimus vs. sirolimus vs. zotarolimus), strut material (platinum‐chromium vs. cobalt‐chromium), polymer (bioresorbable vs. durable), number of crowns (<8 vs. ≥8) and number of connectors (<3 vs. ≥3). For small diameter stents (≤2.5 mm), struct thickness (74 vs. 80/81 μm) was also tested. Target lesion failure (TLF), a composite of target lesion revascularization and stent thrombosis, was the primary endpoint. Multivariate analysis was performed with Cox regression models. Results: Out of 2, 707 patients, 110 (4.1%) experienced a TLF event after 16 months (12–18). After adjustment for confounders, an increased number of connectors (adjusted hazard ratio [adj‐HR] 0.62, 95% confidence interval (CI) 0.39–0.99, p = .04) reduced risk of TLF, driven by stents with ≥2.5 mm diameter (HR 0.54, 95% CI 0.32–0.93, p = .02). This independent relationship was lost for stents with diameter <2.5 mm, where only strut thickness appeared to impact. Conversely, no independent relationship of polymer type, number of crowns, and the specific limus‐family eluted drug with outcomes was observed. Conclusions: Among a range of contemporary very thin stent models, an increased number of connectors improved device‐related outcomes in this investigated high‐risk procedural setting.