Early coronary healing in ST segment elevation myocardial infarction: sirolimus-eluting stents vs. drug-coated balloons after bare-metal stents. The PEBSI-2 optical coherence tomography randomized study. Issue 8 (December 2021)

• Record Type: Journal Article
• Authors: García-Touchard, Arturo; Gonzalo, Nieves; Goicolea, Javier; Gomez-Lara, Josep; Martín-Yuste, Victoria; Peral, Vicente; Martínez-Romero, Pedro; Vaquerizo, Beatriz; Sánchez-Recalde, Ángel; Sarnago, Fernando; Oteo, Juan Francisco; Alfonso, Fernando
• Is Part Of: Coronary artery disease. Volume 32:Issue 8(2021)
• Publication Date: 2021-12
• Subjects: drug-eluting stents -- drug-coated balloons -- myocardial infarction -- mayor coronary evaginations -- optical coherence tomography -- optical coherence tomography; Coronary heart disease -- Periodicals; Coronary Disease -- Indexes; Coronary Disease -- Periodicals; 616.123005
• DOI: 10.1097/MCA.0000000000001038
• Languages: English
• ISSNs: 0954-6928

Abstract

Abstract : Objectives: Drug-coated balloons (DCBs) have theoretical advantages over drug-eluting stents (DESs) to facilitate stent healing. We studied whether, in patients undergoing primary coronary interventions (pPCIs), a strategy of DCB after bare-metal stent improves early healing as determined by optical coherence tomography (OCT) compared with new-generation DES. Methods: pPCI patients were randomized (1:1) to treatment with new-generation sirolimus-eluting stents (DES group) or DCB-strategy. Vessel healing was assessed by OCT at 90 days. Results: Fifty-three patients were randomized (26 DES vs. 27 DCB). At 90 days, both strategies showed a low rate of uncovered struts (3.2 vs. 3.2%, P = 0.64) and a very high and similar rate of covered and apposed struts (96.6 vs. 96.1%, respectively; P = 0.58). However, DCB group had a significantly lower rate of major coronary evaginations (68 vs. 37%, P = 0.026), and more frequently developed a thin homogeneous neointimal layer (20 vs. 70.4%, P = 0.001) suggesting distinct superior healing at 3 months compared to DES. Conclusions: In pPCI both, sirolimus-DES and DCB-strategy, provide excellent strut coverage at 3 months. However, DCB ensures more advanced and optimal stent healing compared to sirolimus-DES. Further research is needed to determine whether, in patients undergoing pPCI, DCB offers superior long-term clinical and angiographic outcomes than new-generation DES (NCT03610347).