Data from randomized studies are also supported by the SCAAR registry, in which ultrathin-strut stents show real-world advantages.
Patients with small vessels who received ultrathin-strut stents are less likely to undergo revascularization at 3 years than those who received first-generation thin-strut devices, according to the BIO-RESORT trial, presented during the first day of the annual PCR Congress and simultaneously published in JAMA.
Ultrathin-strut stents would offer advantages particularly in case of small vessels, due to greater relative impact of strut size and vessel lumen.
Among the 3514 patients enrolled in this three-arm trial, 1506 had at least one lesion with a reference vessel diameter <2.5 mm.
This small-vessel analysis was prespecified in the original protocol.
Beyond PCR, the Swedish registry data also suggested that ultrathin struts offer advantages, not just in small vessels, but in a broader population. Such advantage is basically driven by less revascularization.
The BIO-RESORT study enrolled patients at 4 Dutch centers between December 2012 and August 2015. Patients were randomized to receive the ultrathin sirolimus-eluting stent Orsiro (Biotronik), the very thin everolimus-eluting stent Synergy (Boston Scientific), or the zotarolimus-eluting stent Resolute Integrity (Medtronic), which have strut thicknesses of 60, 74, and 91 µm, respectively.
At 3 years, target lesion failure (defined as cardiac death, target-vessel infarction, or target-lesion revascularization) trended lower for the ultrathin-strut stent group compared with both thin-strut groups (7.0% vs. 10.0%; p = 0.08).
Considering revascularization specifically, there was a clearly significant difference in favor of ultrathin struts (2.1% vs. 5.3%; p = 0.009). That difference is only present at 2 and 3 years.
There were no disparities among the three devices as regards cardiac death, target-vessel infarction, and stent thrombosis.
Original Title: Outcomes in patients treated with thin-strut, very thin-strut, or ultrathin-strut drug-eluting stents in small coronary vessels: a prespecified analysis of the randomized BIO-RESORT trial.
Reference: Buiten RA et al. JAMA Cardiol. 2019; Epub ahead of print.
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