TY - JOUR
T1 - Biolimus-eluting vs. other limus-eluting stents in NSTE-ACS
T2 - A pooled analysis of GLASSY and TWILIGHT
AU - Spirito, Alessandro
AU - Valgimigli, Marco
AU - Cao, Davide
AU - Baber, Usman
AU - Mehta, Shamir R.
AU - Gibson, C. Michael
AU - Steg, Gabriel P.
AU - Sharma, Samin K.
AU - Goel, Ridhima
AU - Huber, Kurt
AU - Kunadian, Vijay
AU - Escaned, Javier
AU - Franzone, Anna
AU - Yaling, Han
AU - Collier, Timothy
AU - Kaul, Upendra
AU - Kornowski, Ran
AU - Krucoff, Mitchell
AU - Moliterno, David
AU - Sartori, Samantha
AU - Owen, Ruth
AU - Zhang, Zhongjie
AU - Dangas, George D.
AU - Kastrati, Adnan
AU - Angiolillo, Dominick J.
AU - Cohen, David J.
AU - Vranckx, Pascal
AU - Windecker, Stephan
AU - Pocock, Stuart
AU - Mehran, Roxana
N1 - Publisher Copyright:
© 2023 Elsevier B.V.
PY - 2023/7/15
Y1 - 2023/7/15
N2 - Background: Biodegradable polymer biolimus-eluting stents (BP-BES) may be associated with better outcomes in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI) compared to other current-generation limus-eluting stents (LES). Aims: To compare BP-BES with other current-generation LES in ACS patients undergoing PCI. Methods: We pooled individual data of Non-ST-segment elevation (NSTE)-ACS patients from two large randomized controlled trials (GLASSY and TWILIGHT). The BP-BES groups consisted mostly of GLASSY patients, while the control group (other current-generation LES) included exclusively TWILIGHT patients. The primary outcome was major adverse cardiovascular events (MACE), including cardiovascular death, myocardial infarction, or stent thrombosis; the key secondary outcome was target-vessel failure (TVF). To account for trial design differences, outcomes were assessed at 3 months (short-term) and between 3 and 12 months (long-term) after PCI and subsequently pooled to estimate the 12-month hazards. Results: Of 7107 and 6053 NSTE-ACS patients included in the short- and long-term analysis, 32.7% and 36.5% received a BP-BES, respectively. Risk of MACE associated with BP-BES versus other LES was similar at short-term (1.1% vs 1.3%, adjusted HR 0.86, 95%CI 0.53–1.38), lower at long-term (1.7% vs 3.1%, adjusted HR 0.49, 95%CI 0.34–0.72), and lower in the entire 12-month period (pooled adjusted HR 0.61, 95%CI 0.45–0.82). The cumulative 12-month risk of TVF was reduced with BP-BES (adjusted HR 0.52, 95%CI 0.38–0.70). Conclusion: BP-BES was associated with lower 12-month risks of MACE and TVF compared to other current generation LES among NSTE-ACS patients treated with abbreviated or standard ticagrelor-based DAPT. These non-randomized findings are hypothesis-generating. Condensed abstract: Differences in clinical outcomes may exist between biodegradable polymer biolimus-eluting stents (BP-BES) and other current-generation limus-eluting stent (LES) in patients with acute coronary syndrome (ACS). We pooled individual data of about 7000 Non-ST-segment elevation ACS patients undergoing PCI and treated with ticagrelor with or without aspirin from two large randomized controlled trials (GLASSY and TWILIGHT). BP-BES patients derived very largely from GLASSY and other LES patients from TWILIGHT. In this population, BP-BES compared to other current generation LES, were associated with a lower 12-month risk of major adverse cardiovascular events and target-vessel failure.
AB - Background: Biodegradable polymer biolimus-eluting stents (BP-BES) may be associated with better outcomes in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI) compared to other current-generation limus-eluting stents (LES). Aims: To compare BP-BES with other current-generation LES in ACS patients undergoing PCI. Methods: We pooled individual data of Non-ST-segment elevation (NSTE)-ACS patients from two large randomized controlled trials (GLASSY and TWILIGHT). The BP-BES groups consisted mostly of GLASSY patients, while the control group (other current-generation LES) included exclusively TWILIGHT patients. The primary outcome was major adverse cardiovascular events (MACE), including cardiovascular death, myocardial infarction, or stent thrombosis; the key secondary outcome was target-vessel failure (TVF). To account for trial design differences, outcomes were assessed at 3 months (short-term) and between 3 and 12 months (long-term) after PCI and subsequently pooled to estimate the 12-month hazards. Results: Of 7107 and 6053 NSTE-ACS patients included in the short- and long-term analysis, 32.7% and 36.5% received a BP-BES, respectively. Risk of MACE associated with BP-BES versus other LES was similar at short-term (1.1% vs 1.3%, adjusted HR 0.86, 95%CI 0.53–1.38), lower at long-term (1.7% vs 3.1%, adjusted HR 0.49, 95%CI 0.34–0.72), and lower in the entire 12-month period (pooled adjusted HR 0.61, 95%CI 0.45–0.82). The cumulative 12-month risk of TVF was reduced with BP-BES (adjusted HR 0.52, 95%CI 0.38–0.70). Conclusion: BP-BES was associated with lower 12-month risks of MACE and TVF compared to other current generation LES among NSTE-ACS patients treated with abbreviated or standard ticagrelor-based DAPT. These non-randomized findings are hypothesis-generating. Condensed abstract: Differences in clinical outcomes may exist between biodegradable polymer biolimus-eluting stents (BP-BES) and other current-generation limus-eluting stent (LES) in patients with acute coronary syndrome (ACS). We pooled individual data of about 7000 Non-ST-segment elevation ACS patients undergoing PCI and treated with ticagrelor with or without aspirin from two large randomized controlled trials (GLASSY and TWILIGHT). BP-BES patients derived very largely from GLASSY and other LES patients from TWILIGHT. In this population, BP-BES compared to other current generation LES, were associated with a lower 12-month risk of major adverse cardiovascular events and target-vessel failure.
KW - Biodegradable polymer
KW - Biolimus eluting stent
KW - Outcomes
KW - Percutaneous coronary intervention
KW - Ticagrelor
UR - http://www.scopus.com/inward/record.url?scp=85154543691&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2023.04.027
DO - 10.1016/j.ijcard.2023.04.027
M3 - Article
C2 - 37080466
AN - SCOPUS:85154543691
SN - 0167-5273
VL - 383
SP - 24
EP - 32
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -