Menown, IBAMamas, MACotton, JMHildick-Smith, DEberli, FRLeibundgut, GTresukosol, DMacAya, CCopt, SSlama, SSOldroyd, KG2021-09-282021-09-282021-04-01Menown, I.B.A., Mamas, M.A., Cotton, J.M. et al. (2021) Thin Strut CoCr biodegradable polymer biolimus A9-eluting stents versus thicker strut stainless steel biodegradable polymer Biolimus A9-eluting stents: Two-year clinical outcomes. Journal of Interventional Cardiology, Article ID 6654515, https://doi.org/10.1155/2021/66545150896-432733880087 (pubmed)10.1155/2021/6654515http://hdl.handle.net/2436/624375© 2021 The Authors. Published by Hindawi. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1155/2021/6654515Background. While thinner struts are associated with improved clinical outcomes in bare-metal stents (BMS), reducing strut thickness may affect drug delivery from drug-eluting stents (DES) and there are limited data comparing otherwise similar thin and thick strut DES. We assessed 2-year outcomes of patients treated with a thin strut (84-88um) cobalt-chromium, biodegradable polymer, Biolimus A9-eluting stent (CoCr-BP-BES) and compared these to patients treated with a stainless steel, biodegradable polymer, Biolimus A9-eluting stent (SS-BP-BES). Methods. In total, 1257 patients were studied: 400 patients from 12 centres receiving ≥1 CoCr-BP-BES in the prospective Biomatrix Alpha registry underwent prespecified comparison with 857 patients who received ≥1 Biomatrix Flex SS-BP-BES in the LEADERS study (historical control). The primary outcome was major adverse cardiac events (MACE)-cardiac death, myocardial infarction (MI), or clinically driven target vessel revascularization (cd-TVR). Propensity analysis was used to adjust for differences in baseline variables and a landmark analysis at day-3 to account for differences in periprocedural MI definitions. Results. MACE at 2 years occurred in 6.65% CoCr-BP-BES versus 13.23% SS-BP-BES groups (unadjusted HR 0.48 [0.31-0.73]; P = 0.0005). Following propensity analysis, 2-year adjusted MACE rates were 7.4% versus 13.3% (HR 0.53 [0.35-0.79]; P = 0.004). Definite or probable stent thrombosis, adjudicated using identical criteria in both studies, occurred less frequently with CoCr-BP-BES (1.12% vs. 3.22%; adjusted HR 0.32 [0.11-0.9]; P = 0.034). In day-3 landmark analysis, the difference in 2-year MACE was no longer significant but there was a lower patient-orientated composite endpoint (11.7% vs. 18.4%; HR 0.6 [0.43-0.83]; P = 0.006) and a trend to lower target vessel failure (5.8% vs. 9.1%; HR 0.63 [0.4-1.00]; P = 0.078). Conclusion. At 2-year follow-up, propensity-adjusted analysis showed the thin strut (84-88um) Biomatrix Alpha CoCr-BP-BES was associated with improved clinical outcomes compared with the thicker strut (114-120um) Biomatrix Flex SSBP- BES.application/pdfenLicence for published version: Creative Commons Attribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/stentsthin strut stentsHumansCoronary ThrombosisMyocardial InfarctionChromium AlloysStainless SteelSirolimusPolymersAnti-Inflammatory AgentsTreatment OutcomeRegistriesFollow-Up StudiesProspective StudiesAbsorbable ImplantsAgedMiddle AgedFemaleMaleCoronary Artery DiseaseAcute Coronary SyndromeDrug-Eluting StentsPercutaneous Coronary InterventionJournal article1540-8183Journal of Interventional Cardiology2021-09-27