29 Oct Heart Attack: Evaluation of Bioabsorbable Drug Eluting Stents
MedicalResearch.com Interview with:
Lorenz Raber, MD
University Hospital Bern
MedicalResearch.com: What are the main findings of the study?
Dr. Raber: The main finding of the clinical study is that the benefit of a biolimus-eluting stent using a biodegradable polymer (Biomatrix, BES) regarding MACE (cardiac death, target vessel MI, TLR) continued to accrue during the second year of follow-up, actually with a similar relative risk reduction as observed during the first year. After one year, the timepoint at which most patients stopped dual antiplatelet therapy (DAPT), no difference in safety (cardiac death, myocardial infarction, stent thrombosis) was observed between BES and the control group (bare metal stent, BMS). This largely confirms the principle concept of biodegradable polymer stent platforms.
The results of the imaging substudy provide a mechanistic explanation for the observed benefit with BES. Specifically, BES showed a lower neointimal thickness, a low frequency of uncovered and malapposed stent struts (OCT) and the absence of positive remodeling (IVUS) at 13 months follow-up.
MedicalResearch.com: Were any of the findings unexpected?
Dr. Raber: The favorable arterial healing profile following BES implantation in culprit lesions of STEMI patients was not anticipated. Early generation DES were associated with a substantial delay in arterial healing, particularly in STEMI lesions. The finding of a lower frequency of athero-thrombotic material in BES as compared to BMS after stent implantation came as a surprise and offers a potential explanation for the lower thrombotic risk observed with newer generation DES compared with BMS.
MedicalResearch.com: What should clinicians and patients take away from your report?
Dr. Raber: The use of BES appears more safe and efficient as compared to a BMS, even after cessation of DAPT. In concert with data on the safety and efficacy of other newer generation DES used for primary PCI, there is not much air left for BMS in primary PCI. Guidelines will sooner or later acknowledge this paradigm shift.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Raber: Newer generation DES appear as the new safety and efficacy benchmark for any future stent comparisons, including fully bioabsorbable scaffolds. Following primary PCI, there is a need to improve early outcomes (e.g. <2 days after stent placement). This might be achieved with the use of novel antithrombotic drugs. The ideal DAPT duration following primary PCI with newer generation DES also remains to be investigated.
Insights into the unique capabilities of bioabsorbable polymer-based drug-eluting stents in high-risk scenarios: 2-year clinical and imaging data from COMFORTABLE AMI