The Long Marathon of Ultrathin vs. 2nd Generation Thin-Strut DES

After 2.5 years of non-stop racing, ultrathin-strut drug-eluting stents (DES) reached the finish line before 2nd generation thin-strut DES.

The advantage was in terms of clinically justified lesion revascularization, while rates of infarction, stent thrombosis, cardiac death, and all-cause death were similar. After failure at trying to create new generations of DES based on drugs or polymers, the real evolution seems to lie on strut thickness.

Contemporary 2nd generation DES are considered the standard of care for coronary angioplasty. A previous meta-analysis of 10 randomized studies with over 11,000 patients showed the advantage of ultrathin DES, but with only with a 1-year follow-up (a very short time to consider the dawn of a new generation).

This new meta-analysis published in the European Heart Journal compared randomized studies with ultrathin DES (<70 microns thick) vs. the classic 2nd generation device.

The pre-specified primary endpoint was target lesion failure, a composite of cardiac death, infarction, or clinically justified target lesion revascularization. Secondary endpoints included stent thrombosis and all-cause mortality.

Sixteen randomized studies with over 20,000 patients and 2.5 years of follow-up were eligible.

Read also: Best Revascularization Strategy in Patients with Left Ventricular Deterioration.

Ultrathin-strut DES were associated with a 15% reduction in long-term target vessel failure compared to “conventional” 2nd generation DES (risk ratio [RR]: 0.85; 95% confidence interval [CI]: 0.76 to 0.96; p = 0.008), led by a 25% reduction in clinically justified revascularization (RR: 0.75; 95% CI: 0.62 to 0.92; p = 0.005).

No differences were observed between the two devices in terms of infarction, stent thrombosis, cardiac death, or all-cause mortality.

Conclusion

At a mean follow-up of 2.5 years, ultrathin-strut stents reduced target vessel failure mainly due to a significant reduction in revascularizations compared with “classical” 2nd generation DES.

Original Title: Long-term follow-up after ultrathin vs. conventional 2nd-generation drug-eluting stents: a systematic review and meta-analysis of randomized controlled trials.

Reference: Mahesh V. Madhavan et al. European Heart Journal (2021) 42, 2643–2654 doi:10.1093/eurheartj/ehab280.

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