Early vascular healing after implantation of the polymer-free biolimus-eluting stent or the ultrathin strut biodegradable polymer sirolimus-eluting stent in patients with ST-segment elevation myocardial infarction

Abstract

Objective 

To evaluate the difference in early vascular healing between the ultrathin-strut biodegradable-polymer sirolimus-eluting Orsiro stent (O-SES) and the polymer-free biolimus-A9-eluting BioFreedom stent (BF-BES), assessed with optical coherence tomography (OCT) after primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarctions (STEMIs).

Methods 

Eighty patients with STEMI who underwent primary PCI were randomly allocated 1:1 to treatment with BF-BES or O-SES. OCT was acquired after PCI and at 1-month follow-up. The primary endpoint was 1-month OCT-assessed vascular healing index based on the presence of uncovered and malapposed stent struts and intraluminal filling defects where low vascular healing index indicated favorable vascular healing.

Results 

At 1-month, the vascular healing index was similar in O-SES 11.5 [interquartile range (IQR) 9.5–17.5], compared to BF-BES 11.5 (IQR 7.1–12.5; P = 0.14). Percentage of uncovered struts [O-SES 31.5% (IQR 20.7–41.9), P = 0.43] vs. BF-BES 27.8% (IQR 19.4–41.9; P = 0.44), and median volume of neointimal hyperplasia [O-SES 4.9 mm³ (IQR 1.4–13.1) vs. BF-BES 7.1 mm³ (IQR 2.8–17.0), P = 0.18] did not differ significantly between the two stent groups. Complete coverage was not observed in any of the stents. The percentages of stents with malapposition did not differ significantly (O-SES 87.1% vs. BF-BES 71.4%, P = 0.14) whereas percentage of malapposed struts [O-SES 3.5% (IQR 0.8–5.5) vs. BF-BES 0.8% (IQR 0.0–1.8), P = 0.003] was lower in the BF-BES group.

Conclusion 

In patients with STEMI, the drug-coated BF-BES and the thin strut O-SES had similar vascular healing index at 1-month. However, the thin O-SES struts were more often malapposed.