ABSTRACT
BACKGROUND Polymer-free drug-coated stents provide superior clinical outcomes to bare-metal stents in patients at high bleeding risk who undergo percutaneous coronary intervention (PCI) and are treated with 1 month of dual antiplatelet therapy. Data on the use of polymer-based drug-eluting stents, as compared with polymer-free drug-coated stents, in such patients are limited. METHODS In an international, randomized, single-blind trial, we compared polymer-based zotarolimus-eluting stents with polymer-free umirolimuscoated stents in patients at high bleeding risk. After PCI, patients were treated with 1 month of dual antiplatelet therapy, followed by single antiplatelet therapy. The primary outcome was a safety composite of death from cardiac causes, myocardial infarction, or stent thrombosis at 1 year. The principal secondary outcome was target-lesion failure, an effectiveness composite of death from cardiac causes, target-vessel myocardial infarction, or clinically indicated target-lesion revascularization. Both outcomes were powered for noninferiority. RESULTS A total of 1996 patients at high bleeding risk were randomly assigned in a 1:1 ratio to receive zotarolimus-eluting stents (1003 patients) or polymer-free drugcoated stents (993 patients). At 1 year, the primary outcome was observed in 169 of 988 patients (17.1%) in the zotarolimus-eluting stent group and in 164 of 969 (16.9%) in the polymer-free drug-coated stent group (risk difference, 0.2 percentage points; upper boundary of the one-sided 97.5% confidence interval [CI], 3.5; noninferiority margin, 4.1; P=0.01 for noninferiority). The principal secondary outcome was observed in 174 patients (17.6%) in the zotarolimus-eluting stent group and in 169 (17.4%) in the polymer-free drug-coated stent group (risk difference, 0.2 percentage points; upper boundary of the one-sided 97.5% CI, 3.5; noninferiority margin, 4.4; P=0.007 for noninferiority). CONCLUSIONS Among patients at high bleeding risk who received 1 month of dual antiplatelet therapy after PCI, use of polymer-based zotarolimus-eluting stents was noninferior to use of polymer-free drug-coated stents with regard to safety and effectiveness composite outcomes. (Funded by Medtronic; ONYX ONE ClinicalTrials.gov number, NCT03344653.). (AU)
Subject(s)
Coronary Artery Disease/drug therapy , Combined Modality Therapy , Sirolimus , Drug-Eluting Stents , Polymers , Double-Blind MethodABSTRACT
Aims: We report the angiographic and clinical outcomes of patients with de novocoronary bifurcation lesions treated with the Nile PAX dedicated device.Methods and results: From Dec/08 to Mar/09, a total of 102 pts with singlebifurcation lesion were prospectively enrolled in this non-randomised, multicenter(10 sites in Europe/South America) study. Lesion criteria were vessel size 2.5-3.5mm in the parent vessel (PV) and 2.0-3.0 mm in the SB, and lesion length <14 mmin the PV. Clinical follow-up (FU) was scheduled at 1, 3, 6, 9 and 12 months, andyearly up to 5 years. Angiographic FU was scheduled at 9 months (primaryendpoint). Angiographic analysis was performed by an independent angiographiccore laboratory. Data analysis and management was performed by an independentdata coordinating center; also, all clinical events were independently adjudicatedby a clinical events committee. Mean age was 63 years, 29% had diabetes, 16previous MI, and 40% previous intervention. The LAD/Dg was the most prevalentlocation (75%), and 60% had significant involvement of both branches. In theprocedure, PV was predilated in 97%; the study stent was successfully attemptedand implanted in 99%. Overall, 25% of SB received an additional stent; and 94%of lesions had final kissing-balloon inflation. By quantitative coronary angiography,baseline mean lesion length, vessel diameter and% diameter stenosis were: 10.9mm, 2.99 mm and 72% in the PV, and 4.1 mm, 2.28 mm, and 38% in the SB, respectively. Angiographic success (residual stenosis <50%, final TIMI 3 flow, andabsence of dissection) was achieved in 98%. There was only 1 major adversecardiac event (MACE) during hospitalisation, which was adjudicated as a non-Qmyocardial infarction during hospitalisation, and no additional adverse events werereported up to 30 days...