Twelve-month comparative analysis of clinical outcomes using biodegradable polymer-coated everolimus-eluting stents versus durable polymer-coated everolimus-eluting stents in all-comer patients

Ultrathin, biodegradable polymer-coated everolimus-eluting stents for patients undergoing percutaneous coronary intervention: Final three-year results of the PERFORM-EVER registry

The registry reports 3-year safety and clinical performance of the ultrathin strut (60 μm) biodegradable polymer-coated Tetrilimus, an everolimus-eluting stent (EES) (Sahajanand Medical Technologies Limited, India), in 'real-world' patients with coronary artery disease. A total of 815 Tetrilimus EES were implanted in 735 lesions in 594 patients. At 3-year follow-up, primary endpoint (target lesion failure, TLF) was reported in 8.6 % patients, including 2.6 % cardiac deaths, 3.5 % myocardial infarction and 2.6 % target lesion revascularization. At three-year, no cases of definite stent thrombosis were reported. The final three-year results of PERFORM-EVER registry endorse the continuous safety and effectiveness Tetrilimus EES.

Ultra-thin everolimus-eluting stents in atherosclerotic lesions: Three years follow-up with subgroup analysis of ultra-long stents

OBJECTIVES

To assess the long-term (3 years) safety and efficacy of Tetrilimus everolimus-eluting stent (EES) and subgroup analysis of outcomes of ultra-long (44/48 mm) Tetrilimus EES implantation in patients with long coronary lesions.

MATERIAL AND METHODS

In this observational, single-centre, single-arm, investigator-initiated registry, 558 patients who underwent implantation of Tetrilimus EES for the treatment of coronary artery disease were retrospectively included. The primary endpoint was occurrence of any major adverse cardiac event (MACE) at 12 months follow-up (composite of cardiac death, myocardial infarction [MI], and target lesion revascularization [TLR]) and we hereby report 3 years follow-up data. Stent thrombosis was assessed as a safety endpoint. A subgroup analysis of patients with long coronary lesions is also reported.

RESULTS

A total of 558 patients (57.0 ± 10.2 years) received 766 Tetrilimus EES (1.3 ± 0.5 stents/patient) to treat 695 coronary lesions. In subgroup analysis of 143 patients implanted with ultra-long EES, 155 lesions were intervened successfully with only one Tetrilimus EES (44/48 mm) implanted per lesion. At 3 years, event rates of 9.1% MACE with predominance of MI (4.4%), followed by 2.9% TLR and 1.7% cardiac death, and only 1.0% stent thrombosis were reported in overall population, while in a subgroup of patients implanted with ultra-long EES, 10.4% MACE and 1.5% stent thrombosis were reported.

CONCLUSIONS

Three years clinical outcomes showed favourable long-term safety and excellent performance of Tetrilimus EES in high-risk patients and complex coronary lesions in routine clinical practice, including a subgroup of patients with long coronary lesions, with acceptable primary and safety endpoints.

Real-World Clinical Outcomes of Indigenous Biodegradable Polymer Drug-Eluting Stents

Introduction

The durable polymer has been shown to cause neoatherosclerosis, and chronic local inflammation, predisposing individuals to in-stent restenosis and stent thrombosis (ST). The biodegradable polymer stents, which degrade after the desired function of drug release is achieved, allow for endothelial healing. Indigenous coronary stent manufacturing and its use are on the rise nowadays, and their safety and efficacy have been studied in well-structured clinical trials. However, data are scarce on their safety and efficacy in the real-world clinical setting. In this study, we examine the real-world one-year performance of bioresorbable or polymer-free stents manufactured in India.

Materials and methods

This was a single-center, single-arm prospective observational study involving 210 patients undergoing intracoronary stenting using bioabsorbable or polymer-free drug-eluting stents (DES) from Indian manufacturers. All patients were followed up for 12 months prospectively for any major clinical events.

Results

The mean age of the enrolled patients was 57.04 years (IQR: 34-84 years), among which 159 (75.7%) were male; 99 (43.8%) patients had presented with acute myocardial infarction (MI). A total of 294 stents were deployed with a mean diameter of 3.1 ±0.4 mm, and a mean length of 29.4 ±9.1 mm. Two patients had experienced major adverse cardiovascular events (MACE). After three months of follow-up, one patient developed ST, and the same patient developed a cerebrovascular accident (CVA) after six months. After one year of follow-up, one patient died of cardiac causes.

Conclusion

Based on our findings, in the real-world clinical setting, the indigenously made biodegradable polymer DES are both safe and effective.

Safety and performance of the EverProTM everolimus-eluting coronary stent system with biodegradable polymer in a real-world scenario

BACKGROUND

The EverPro^TM (Sahajanand Laser Technology Ltd., India) everolimus-eluting coronary stent system (EES) is a second-generation drug-eluting stent with a biodegradable polymer.

AIM

To determine the safety and performance of the EverPro^TM EES in patients with coronary artery disease (CAD) during a 1-year clinical follow-up.

METHODS

This observational, retrospective, single-center study enrolled patients who had been implanted with the EverPro^TM stent between June 1, 2018 and January 31, 2019, and had completed a 1-year follow-up period after the index procedure. The primary clinical endpoint was major adverse cardiac events (MACE) at 6 mo defined as the composite of cardiac death, myocardial infarction (MI), and target lesion revascularization (TLR). Secondary endpoints were the incidence of TLR at 1, 6 and 12 mo follow-up, MACE at 1 and 12 mo follow-up, and stent thrombosis up to 1 year after the index procedure.

RESULTS

The study population comprised 77 patients (98 lesions). A total of 37 (48.1%) patients had comorbid hypertension. In total, 26 (33.8%) patients presented with ST segment elevation MI and 10.4% patients with non-ST segment elevation MI. Treated lesions were located mainly in the left anterior descending artery (49%) followed by the right coronary artery (29.6%), left circumflex (12.2%) and obtuse marginal (9.2%) arteries. The majority of patients were with single-vessel disease (79%), 22.2% of lesions had a mild to severe thrombus load, and 94.9% were American College of Cardiology/American Heart Association type B or C. De novo stenting was performed in 96.9% of patients and 3% were treated for in-stent restenosis. Procedural success was attained in all patients. In-hospital or follow-up MACE and stent thrombosis were not reported during the 1-year follow-up period.

CONCLUSION

These findings suggest that the EverPro^TM EES is a safe and effective treatment option with no MACE or stent thrombosis reported during the 1-year study period in patients with CAD.

Procedural safety and outcome of ultrathin strut stents (<60 μm) in the management of very long coronary artery stenosis (>30 mm) - A retrospective real world study

BACKGROUND

The ultrathin strut stents (<60 μm) are new in the current stents technology. This technology has assured to have less stent thrombosis, restenosis and better deliverability. Still there is lacking data of using long ultrathin strut stents in very long segment coronary artery disease (>30 mm).

AIM

The aim of this retrospective study was to assess the procedural safety and outcome of using ultrathin strut stents in very long segment coronary artery lesion.

METHODS

In this retrospective analysis, we have enrolled those patients who had an implant of more than 30 mm length of ultrathin strut stents (Evermine 50^TM and Tetrilimus stents) in real world patients as per physician discretion. Here, we enrolled 156 patients which included both acute coronary syndrome (ACS) and stable ischemic heart disease (SIHD). The endpoint of this study was to evaluate the immediate procedural success and short to intermediate term follow-up of all-cause mortality and clinically driven target lesion revascularization.

RESULTS

Out of these 156 patients (mean age- 61.2 +/- 10.4 years; male: 114), in 12 patients, these long stents couldn't be delivered. In rest 144 patients, 147 ultrathin strut stents were implanted. In about 56% patients were hypertensive and 48% patients were diabetic. About 63% patients had ACS and rest 37% patients had SIHD. The mean duration of follow up was 8.4 +/- 13.9 months. Average stent length and diameter were 39.5 +/- 5.9 mm and 3.03 +/- 0.4 mm, respectively. There was no acute or sub-acute stent thrombosis and no procedural complication. Five patients died during follow-up (all-cause mortality) and rest are all symptoms free. There were no statistical significant differences seen among the stent types.

CONCLUSION

Ultrathin strut stents can be considered for stenting in long segment coronary artery stenosis with reasonably good procedural success rate and have good clinical outcome, but needs further large randomized trial before using in this particular clinical condition. Both the stent designs have similar clinical outcome and procedural success.