Individual patient data analysis of the BIOFLOW study program comparing safety and efficacy of a bioresorbable polymer sirolimus eluting stent to a durable polymer everolimus eluting stent.

Abstract

OBJECTIVES:

This analysis of pooled individual patient data (IPD) aimed to evaluate the safety and efficacy of a bioresorbable polymer sirolimus eluting stent system (BP-SES; Orsiro) compared to a durable polymer everolimus eluting stent system (DP-EES; Xience) in the pooled population as well as in subgroups.

METHODS:

IPD with up to 12 months follow-up of the randomized controlled trials BIOFLOW-II (NCT01356888), -IV (NCT01939249), and -V (NCT02389946) as well as the all comers registry BIOFLOW-III (NCT01553526) were pooled. A total of 3,717 subjects (2,923 in BP-SES and 794 in DP-EES) with 5,328 lesions (4,225 lesions in BP-SES and 1,103 in DP-EES) were included in the IPD. The primary endpoint was target lesion failure (TLF) at 12 months follow-up. Subgroups analyzed included diabetes, age (≥65 years), gender, complex lesions (B2/C), small vessels (reference vessel diameter ≤2.75 mm), multivessel treatment, renal disease, and patients with acute coronary syndrome.

RESULTS:

Overall, TLF at 12 months was significantly lower with 5.2%in the BP-SES group versus 7.6% in the DP-EES group (p = .0098). Similarly, target vessel myocardial infarction (TV-MI) was 3.1 versus 5.7% (p = .0005). The rate of stent thrombosis was similar in both groups (0.004%). By regression analysis, an independent stent effect in favor of BP-SES was observed for TLF (p = .0043) and TV-MI (p = .0364) in small vessels.

CONCLUSION:

Results of this IPD analysis suggest that the BP-SES with ultrathin struts is as safe as and more efficacious than DP-EES in the overall cohort and especially in small vessels.

• Authors: Ralph Toelg, Ton Slagboom, Johannes Waltenberger, Thierry Lefèvre, Shigeru Saito, David E Kandzari, Jacques Koolen, Gert Richardt
• Journal: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (Catheter Cardiovasc Interv) Vol. 98 Issue 5 Pg. 848-856 (11 01 2021) ISSN: 1522-726X [Electronic] United States
• PMID: 32890442 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: © 2020 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.

Chemical References

• Polymers
• Everolimus
• Sirolimus

Topics

• Absorbable Implants
• Aged
• Coronary Artery Disease (diagnostic imaging, therapy)
• Data Analysis
• Drug-Eluting Stents (adverse effects)
• Everolimus (adverse effects)
• Humans
• Polymers
• Prosthesis Design
• Sirolimus (adverse effects)
• Treatment Outcome