Coronary disease & ACSSecondary analysis
Impact of total stent length on long-term outcomes with different newer-generation drug-eluting stent designs in ST-segment elevation myocardial infarction: A subgroup analysis from the BIOSTEMI ES randomized trial
- post hoc subgroup analysis of the BIOSTEMI Extended Survival randomized trial
Authors' conclusion
In STEMI patients treated with contemporary DES, TSL >40 mm was associated with an increased risk of patient-oriented, but not device-related, adverse outcomes at 5 years. Among patients requiring TSL >40 mm, ultrathin-strut BP-SES significantly reduced the risk of TLF compared with DP-EES, whereas no between-DES differences were observed in patients treated with TSL ≤40 mm.
Study context
- Population
- Patients undergoing primary percutaneous coronary intervention for STEMI, randomized to biodegradable-polymer sirolimus-eluting stents (BP-SES) or durable-polymer everolimus-eluting stents (DP-EES) and categorized according to total stent length (TSL) implanted at the culprit siteSTEMI patients included, 423 (25%) treated with TSL >40 mm
- Participants
- 1,686 patients
- Comparison
- TSL >40 mm vs TSL ≤40 mm, and BP-SES vs DP-EES within TSL categories
- TSL >40 mmn = 423
Primary result
As reported in the abstract
- All-cause death
- Any myocardial reinfarction
- Any revascularization
- Any stroke
Hazard ratio
1.30
95% CI 1.03–1.64
P = 0.029
By group
Further findings
| Outcome | TSL >40 mm | TSL ≤40 mm | BP-SES | DP-EES | Estimate | P value | |
|---|---|---|---|---|---|---|---|
| TLF among patients with TSL >40 mm (subgroup) · 5 years | Not reported in the abstract | Not reported in the abstract | 7.3% | 17.1% | HR 0.39 (95% CI 0.21–0.74) | P = 0.004 | |
| TLF per 5-mm increase in TSL with DP-EES · adjusted for multivessel treatment; not observed with BP-SES | adjusted HR 1.07 (95% CI 1.02–1.11) | P = 0.003 | |||||
| 0.20.5125Ratio (log scale) |
- Target lesion failure (TLF) among patients with TSL >40 mm (subgroup): lower risk with BP-SES; primarily driven by a lower rate of target vessel myocardial reinfarction
- TLF among patients with TSL >40 mm (subgroup): P for interaction = .032
TLF (cardiac death, target-vessel myocardial reinfarction, or clinically indicated target lesion revascularization), TSL >40 mm vs ≤40 mm · 5 years
- no difference was observed in TLF
- significant interaction between drug-eluting stents (DES) type and TSL for TLF at 5 years
Outcomes among patients with TSL ≤40 mm (subgroup)
- No significant differences between BP-SES and DP-EES
Original publication
Summarised from the published abstract; every number is checked against it