Comparison between biodegradable polymer drug eluting stents and durable polymer drug eluting stents on the outcome of percutaneous coronary intervention in patients of Acute Coronary Syndrome

ABSTRACT Introduction: Patients with NSTEACS have a wide spectrum of risk of death and cardiac ischemic events. Biodegradable polymer-based DES have been established as a safe and effective alternative to durable polymer-based stent platforms as evidenced in several randomized clinical trials. Aim of the study: to assess of the role of biodegradable polymer DES in decreasing the incidence of major adverse cardiac events in comparison with durable polymer DES in patients with NSTEACS. Methods: 121 patients enrolled in the study divided into; group A: biodegradable polymer DES and group B: durable polymer DES. Patients presented with NSTEACS having TIMI risk score ≥ 3 were subjected to early invasive strategy. One year views after the index procedure coronary angiography were evaluated by quantitative coronary angiography (QCA) with edge detection method used for evaluation of coronary lesion in index and follow up procedures. Minimal luminal diameter (MLD), reference vessel diameter (RVD), percent diameter stenosis (%DS), acute gain, late loss and late loss index were estimated. Results: There were 155 targeted segments in 146 vessels in our patients with stenosis percentage ≥60%. TIMI 0 was achieved in 0.82% of treated segments, TIMI 1 was achieved in 1.7% of treated segments, TIMI 2 was achieved in 5.8% of treated segments, and TIMI 3 was achieved in 92.6% of treated segments (p-value NS). For biodegradable polymer DES group, 71 stents have been implanted. For durable polymer DES, 86 stents have been implanted. Restoring TIMI flow III after the PCI procedure was achieved in 92.6% of treated segments. Clinical success was achieved in 93.4% of cases. Thirty nine patients had repeated coronary angiography within 1 year (15 biodegradable DES and 24 durable DES). Eighteen patients experienced angina pains for which they were examined thoroughly (8 biodegradable DES and 10 durable DES). Only five patients needed TLR (2 biodegradable DES & 3 durable polymer DES). Three of them had a myocardial infarction with documented angiographic evidence of significant in-stent restenosis (1 biodegradable polymer DES & 2 durable polymer DES) (p-value NS). Conclusion: Biodegradable polymer and durable polymer DES are associated with similar clinical outcomes at 1 year. Biodegradable polymer DES is a safe alternative to durable polymer DES. Kew word: Non-ST segment elevation acute coronary syndrome, biodegradable polymer DES, major adverse cardiac events REFERENCES Cayla G, Silvain J, Collet JP and Montalescot G. Updates and current recommendations for the management of patients with non-ST-elevation acute coronary syndromes: what it means for clinical practice. Am J Cardiol, 2015. 115(5 Suppl): p. 10A-22A. Htay T and Liu MW. Drug-eluting stent: a review and update. Vasc Health Risk Manag, 2005. 1(4): p. 263-76. Stettler C, Wandel S, Allemann S, et al. Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis. Lancet, 2007. 370(9591): p. 937-48. Kastrati, A., Mehilli J, Pache J, et al. Analysis of 14 trials comparing sirolimus-eluting stents with bare-metal stents. N Engl J Med, 2007. 356(10): p. 1030-9. Finn AV, Nakazawa G, Joner M, Kolodgie FD, Mont EK, Gold HK, and Virmani R. Vascular responses to drug eluting stents: importance of delayed healing. Arterioscler Thromb Vasc Biol, 2007. 27(7): p. 1500-10. Byrne RA, Joner M, and Kastrati A. Polymer coatings and delayed arterial healing following drug-eluting stent implantation. Minerva Cardioangiol, 2009. 57(5): p. 567-84. Mehilli J, Byrne RA, Wieczorek A, et al. Randomized trial of three rapamycin-eluting stents with different coating strategies for the reduction of coronary restenosis. Eur Heart J, 2008. 29(16): p. 1975-82. Windecker S, Serruys PW, Wandel S, et al. Biolimus-eluting stent with biodegradable polymer versus sirolimus-eluting stent with durable polymer for coronary revascularisation (LEADERS): a randomised non-inferiority trial. Lancet, 2008. 372(9644): p. 1163-73. Barlis P, Regar E, Serruys PW, et al. An optical coherence tomography study of a biodegradable vs. durable polymer-coated limus-eluting stent: a LEADERS trial sub-study. Eur Heart J, 2010. 31(2): p. 165-76. Sanborn TA, Tcheng JE, Anderson HV, et al. ACC/AHA/SCAI 2014 health policy statement on structured reporting for the cardiac catheterization laboratory: a report of the American College of Cardiology Clinical Quality Committee. Circulation, 2014. 129(24): p. 2578-609. Kolh P and Windecker S. ESC/EACTS myocardial revascularization guidelines 2014. Eur Heart J, 2014. 35(46): p. 3235-6. Pollack CV, Sites FD, Shofer FS, Sease KL, and Hollander JE. Application of the TIMI risk score for unstable angina and non-ST elevation acute coronary syndrome to an unselected emergency department chest pain population. Acad Emerg Med, 2006. 13(1): p. 13-8. Nesković AN, Otasević P, Bojić M, and Popović AD. Association of Killip class on admission and left ventricular dilatation after myocardial infarction: a closer look into an old clinical classification. Am Heart J, 1999. 137(2): p. 361-7. Windecker S, Haude M, Neumann FJ, et al. Comparison of a novel biodegradable polymer sirolimus-eluting stent with a durable polymer everolimus-eluting stent: results of the randomized BIOFLOW-II trial. Circ Cardiovasc Interv, 2015. 8(2): p. e001441. Sateesh Pujari, & Estari Mamidala. (2015). Anti-diabetic activity of Physagulin-F isolated from Physalis angulata fruits. The American Journal of Science and Medical Research, 1(2), 53–60. https://doi.org/10.5281/zenodo.7352308 Jinnouchi H, Kuramitsu S, Shinozaki T, et al. Two-year clinical outcomes of the NOBORI biolimus-eluting stents versus XIENCE/PROMUS everolimus-eluting stents in small vessel disease. Catheter Cardiovasc Interv, 2016. 88(5):E132-E138. Stefanini GG, Byrne RA, Serruys PW, et al. Biodegradable polymer drug-eluting stents reduce the risk of stent thrombosis at 4 years in patients undergoing percutaneous coronary intervention: a pooled analysis of individual patient data from the ISAR-TEST 3, ISAR-TEST 4, and LEADERS randomized trials. Eur Heart J, 2012. 33(10): p. 1214-22