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Safety and efficacy of the bioabsorbable polymer everolimus‐eluting stent versus durable polymer drug‐eluting stents in high‐risk patients undergoing PCI : TWILIGHT‐SYNERGY
Author(s) -
Baber Usman,
Chandiramani Rishi,
Mehta Shamir R.,
Sartori Samantha,
Zhang Zhongjie,
Claessen Bimmer E.,
Briguori Carlo,
Sharma Samin,
Dangas George,
Mehran Roxana
Publication year - 2021
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.28995
Subject(s) - medicine , ticagrelor , conventional pci , percutaneous coronary intervention , aspirin , stent , myocardial infarction , target lesion , everolimus , stroke (engine) , cardiology , drug eluting stent , surgery , mechanical engineering , engineering
Background Data examining the safety and efficacy of the bioabsorbable polymer (BP) drug‐eluting stent (DES) as compared with durable polymer (DP) DES in high‐risk patients undergoing percutaneous coronary intervention (PCI) remain limited. Methods We conducted a pre‐specified analysis among patients enrolled in the TWILIGHT trial treated with the SYNERGY BP‐DES or a DP‐DES. Following successful PCI and 3 months of ticagrelor plus aspirin, patients were randomized to aspirin or placebo for 1 year; DES choice was at physician discretion. The primary endpoint was target lesion failure (TLF) [composite of cardiac death, target vessel myocardial infarction (MI), clinically driven target lesion revascularization (TLR) or definite/probable stent thrombosis (ST)]. Results Among enrolled participants ( N = 9,006), 653 were treated exclusively with the SYNERGY BP‐DES and 6,404 with a comparator DP‐DES. Over 15 months, TLF rates were 6.4 and 6.1% among those receiving a SYNERGY BP‐DES and a DP‐DES, respectively (adjusted HR 0.93; 95% CI 0.64–1.35; p = .72). The effect of ticagrelor monotherapy on Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding and the composite of all‐cause death, MI or stroke was uniform across DES groups (both p int > .10). Conclusions The safety and efficacy profile of the SYNERGY BP‐DES is comparable to that of contemporary DP‐DES in high‐risk patients undergoing PCI. Compared to ticagrelor plus aspirin, the effect of ticagrelor monotherapy is consistent among patients receiving SYNERGY BP‐DES or DP‐DES.