Impact of structural features of very thin stents implanted in unprotected left main or coronary bifurcations on clinical outcomes
Mario Iannaccone
(1)
,
Fabrizio d'Ascenzo
(2)
,
Guglielmo Gallone
(2)
,
Satoru Mitomo
(3)
,
Radosław Parma
(4)
,
Daniela Trabattoni
(3)
,
Nicola Ryan
(5)
,
Saverio Muscoli
(6)
,
Giuseppe Venuti
(7)
,
Andrea Montabone
(8)
,
Francesca de Lio
(2)
,
Lorenzo Zaccaro
(2)
,
Giorgio Quadri
(9)
,
Ovidio de Filippo
(2)
,
Wojciech Wojakowski
(4)
,
Andrea Rognoni
(10)
,
Gerard Helft
(11, 12)
,
Diego Gallo
(13)
,
Leonardo de Luca
(14)
,
Filippo Figini
(15)
,
Yoichi Imori
(16)
,
Federico Conrotto
(2)
,
Giacomo Boccuzzi
(8)
,
Alessio Mattesini
(17)
,
Wojciech Wańha
(4)
,
Grzegorz Smolka
(4)
,
Zenon Huczek
(18)
,
Cristina Rolfo
(9)
,
Mauro Pennone
(2)
,
Bernardo Cortese
(19)
,
Davide Capodanno
(7)
,
Alaide Chieffo
(3)
,
Ivan Nuñez-Gil
(5, 20)
,
Umberto Morbiducci
(13)
,
Maurizio d'Amico
(2)
,
Ferdinando Varbella
(9)
,
Francesco Romeo
(6)
,
Imad Sheiban
(15)
,
Javier Escaned
(5, 20)
,
Roberto Garbo
(8)
,
Claudio Moretti
(21, 2)
,
Carlo Di Mario
(17)
,
Gaetano de Ferrari
(2, 21)
1
CH2SA -
Civil Hospital SS. Annunziata [Savigliano, Italy]
2 UNITO - Università degli studi di Torino = University of Turin
3 IRCCS Ospedale San Raffaele [Milan, Italy]
4 SUM - Medical University of Silesia
5 IdISSC - Instituto de Investigación Sanitaria del Hospital Clínico San Carlos [Madrid, Spain]
6 Università degli Studi di Roma Tor Vergata [Roma, Italia] = University of Rome Tor Vergata [Rome, Italy] = Université de Rome Tor Vergata [Rome, Italie]
7 Unict - Università degli studi di Catania = University of Catania
8 OSGB - Ospedale San Giovanni Bosco [Turin, Italy]
9 OR - Ospedale di Rivoli [Rivoli, Italy]
10 University Hospital “Maggiore della Carità” [Novara, Italy]
11 Institut de cardiologie [CHU Pitié-Salpêtrière]
12 SU FM - Sorbonne Université - Faculté de Médecine
13 Polito - Politecnico di Torino = Polytechnic of Turin
14 OSGE - Ospedale San Giovanni Evangelista [Rome, Italy]
15 CP - Clinica Pederzoli [Peschiera del Garda, Italy]
16 Nippon Medical School [Tokyo, Japon]
17 AOUC - Azienda Ospedaliero Universitaria Careggi [Firenze] = Careggi University Hospital [Florence, Italy]
18 Medical University of Warsaw - Poland
19 ASST Fatebenefratelli-Sacco [Milan, Italy]
20 UCM - Universidad Complutense de Madrid = Complutense University of Madrid [Madrid]
21 Azienda Ospedalerio - Universitaria Città della Salute e della Scienza di Torino = University Hospital Città della Salute e della Scienza di Torino
2 UNITO - Università degli studi di Torino = University of Turin
3 IRCCS Ospedale San Raffaele [Milan, Italy]
4 SUM - Medical University of Silesia
5 IdISSC - Instituto de Investigación Sanitaria del Hospital Clínico San Carlos [Madrid, Spain]
6 Università degli Studi di Roma Tor Vergata [Roma, Italia] = University of Rome Tor Vergata [Rome, Italy] = Université de Rome Tor Vergata [Rome, Italie]
7 Unict - Università degli studi di Catania = University of Catania
8 OSGB - Ospedale San Giovanni Bosco [Turin, Italy]
9 OR - Ospedale di Rivoli [Rivoli, Italy]
10 University Hospital “Maggiore della Carità” [Novara, Italy]
11 Institut de cardiologie [CHU Pitié-Salpêtrière]
12 SU FM - Sorbonne Université - Faculté de Médecine
13 Polito - Politecnico di Torino = Polytechnic of Turin
14 OSGE - Ospedale San Giovanni Evangelista [Rome, Italy]
15 CP - Clinica Pederzoli [Peschiera del Garda, Italy]
16 Nippon Medical School [Tokyo, Japon]
17 AOUC - Azienda Ospedaliero Universitaria Careggi [Firenze] = Careggi University Hospital [Florence, Italy]
18 Medical University of Warsaw - Poland
19 ASST Fatebenefratelli-Sacco [Milan, Italy]
20 UCM - Universidad Complutense de Madrid = Complutense University of Madrid [Madrid]
21 Azienda Ospedalerio - Universitaria Città della Salute e della Scienza di Torino = University Hospital Città della Salute e della Scienza di Torino
Fabrizio d'Ascenzo
- Fonction : Auteur
- PersonId : 785116
- ORCID : 0000-0002-6646-9317
Guglielmo Gallone
- Fonction : Auteur
- PersonId : 805208
- ORCID : 0000-0001-8011-6844
Ovidio de Filippo
- Fonction : Auteur
- PersonId : 805209
- ORCID : 0000-0002-4915-9501
Résumé
Objectives: To evaluate the independent clinical impact of stent structural features in a large cohort of patients undergoing unprotected left main (ULM) or coronary bifurcation percutaneous coronary intervention (PCI) with a range of very thin strut stents.
Background: Clinical impact of structural features of contemporary stents remains to be defined.
Methods: All consecutive patients enrolled in the veRy thin stents for patients with left mAIn or bifurcatioN in real life (RAIN) registry were included. The following stent structural features were studied: antiproliferative drugs (everolimus vs. sirolimus vs. zotarolimus), strut material (platinum-chromium vs. cobalt-chromium), polymer (bioresorbable vs. durable), number of crowns (<8 vs. ≥8) and number of connectors (<3 vs. ≥3). For small diameter stents (≤2.5 mm), struct thickness (74 vs. 80/81 μm) was also tested. Target lesion failure (TLF), a composite of target lesion revascularization and stent thrombosis, was the primary endpoint. Multivariate analysis was performed with Cox regression models.
Results: Out of 2,707 patients, 110 (4.1%) experienced a TLF event after 16 months (12-18). After adjustment for confounders, an increased number of connectors (adjusted hazard ratio [adj-HR] 0.62, 95% confidence interval (CI) 0.39-0.99, p = .04) reduced risk of TLF, driven by stents with ≥2.5 mm diameter (HR 0.54, 95% CI 0.32-0.93, p = .02). This independent relationship was lost for stents with diameter <2.5 mm, where only strut thickness appeared to impact. Conversely, no independent relationship of polymer type, number of crowns, and the specific limus-family eluted drug with outcomes was observed.
Conclusions: Among a range of contemporary very thin stent models, an increased number of connectors improved device-related outcomes in this investigated high-risk procedural setting.