Interpreting clinical outcomes using different strut thickness in coronary artery disease: insights from vascular imaging analysis

Ju-Seung Kwun; Jin Joo Park; Si-Hyuck Kang; Sun-Hwa Kim; Chang-Hwan Yoon; Jung-Won Suh; Tae-Jin Youn; Kwang Soo Cha; Seung-Hwan Lee; Bum-Kee Hong; Seung-Woon Rha; Woong Chol Kang; In-Ho Chae

doi:Background: Coronary artery disease is a global health concern that necessitates treatments, such as percutaneous coronary intervention (PCI) with drug-eluting stents (DES). Recent advancements in biodegradable polymer-coated DES have improved long-term outcomes by reducing neointimal hyperplasia. Superior long-term outcomes in patients with ultrathin-strut sirolimus-eluting Orsiro stent (BP-SES) compared with those with thick-strut biolimus-eluting BioMatrix stent (BP-BES) have been shown. This study aimed to explore the mechanisms underlying these differences by using quantitative coronary angiography (QCA) and optical coherence tomography (OCT).

Methods: This sub-analysis of the BIODEGRADE trial, a prospective, randomized, multi-center study, compared BP-SES and BP-BES in patients who underwent PCI between July 2014 and September 2017. Patients with positive stress test results, ischemic symptoms, or those who consented to routine follow-up angiography were included. QCA and OCT were used to evaluate the lumen diameter, cross-sectional areas and stent apposition or coverage. OCT images were analyzed at 1 mm intervals within 5 mm proximal and distal to the stented segment.

Results: Of the 2,341 patients, 689 underwent follow-up angiography between 18- and 36-months post-PCI, and 929 stents were analyzed via QCA. OCT images of 61 participants were available. The BP-SES group exhibited a significantly larger minimal lumen diameter and reduced late lumen loss compared to the BP-BES group (0.34 ± 0.45 mm vs. 0.42 ± 0.44 mm, P = 0.005). OCT analysis showed significantly less neointimal hyperplasia in the BP-SES group (0.04 ± 0.4 mm2 vs. 0.64 ± 0.54 mm2, P < 0.001), with no significant differences in stent strut coverage or inflammation markers, than in the BP-BES group.

Conclusions: QCA and OCT analyses revealed less neointimal growth with BP-SES than with BP-BES, without delayed healing or increased inflammation. These findings underscore the importance of stent design characteristics and suggest that thinner struts may enhance clinical success by reducing restenosis and improving long-term vessel patency.

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Interpreting clinical outcomes using different strut thickness in coronary artery disease: insights from vascular imaging analysis

Authors: Ju-Seung Kwun ; Jin Joo Park ; Si-Hyuck Kang ; Sun-Hwa Kim ; Chang-Hwan Yoon ; Jung-Won Suh ; Tae-Jin Youn ; Kwang Soo Cha ; Seung-Hwan Lee ; Bum-Kee Hong ; Seung-Woon Rha ; Woong Chol Kang ; In-Ho Chae

Citation: FRONTIERS IN CARDIOVASCULAR MEDICINE, Vol.12 : 1491607, 2025-03

Journal Title: FRONTIERS IN CARDIOVASCULAR MEDICINE

Issue Date: 2025-03

MeSH: 0

Abstract: coronary artery disease ; optical coherence tomography ; percutaneous coronary intervention ; quantitative coronary analysis ; ultrathin-strut drug-eluting stent

Article Number: 10.3389/fcvm.2025.1491607

DOI: Background: Coronary artery disease is a global health concern that necessitates treatments, such as percutaneous coronary intervention (PCI) with drug-eluting stents (DES). Recent advancements in biodegradable polymer-coated DES have improved long-term outcomes by reducing neointimal hyperplasia. Superior long-term outcomes in patients with ultrathin-strut sirolimus-eluting Orsiro stent (BP-SES) compared with those with thick-strut biolimus-eluting BioMatrix stent (BP-BES) have been shown. This study aimed to explore the mechanisms underlying these differences by using quantitative coronary angiography (QCA) and optical coherence tomography (OCT). Methods: This sub-analysis of the BIODEGRADE trial, a prospective, randomized, multi-center study, compared BP-SES and BP-BES in patients who underwent PCI between July 2014 and September 2017. Patients with positive stress test results, ischemic symptoms, or those who consented to routine follow-up angiography were included. QCA and OCT were used to evaluate the lumen diameter, cross-sectional areas and stent apposition or coverage. OCT images were analyzed at 1 mm intervals within 5 mm proximal and distal to the stented segment. Results: Of the 2,341 patients, 689 underwent follow-up angiography between 18- and 36-months post-PCI, and 929 stents were analyzed via QCA. OCT images of 61 participants were available. The BP-SES group exhibited a significantly larger minimal lumen diameter and reduced late lumen loss compared to the BP-BES group (0.34 ± 0.45 mm vs. 0.42 ± 0.44 mm, P = 0.005). OCT analysis showed significantly less neointimal hyperplasia in the BP-SES group (0.04 ± 0.4 mm2 vs. 0.64 ± 0.54 mm2, P < 0.001), with no significant differences in stent strut coverage or inflammation markers, than in the BP-BES group. Conclusions: QCA and OCT analyses revealed less neointimal growth with BP-SES than with BP-BES, without delayed healing or increased inflammation. These findings underscore the importance of stent design characteristics and suggest that thinner struts may enhance clinical success by reducing restenosis and improving long-term vessel patency.

Appears in Collections:: 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers

Yonsei Authors: Hong, Bum Kee(홍범기) https://orcid.org/0000-0002-6456-0184

URI: https://ir.ymlib.yonsei.ac.kr/handle/22282913/207518

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