Can we improve patient outcomes with drug-eluting stents through abluminal biodegradable polymers?

This symposium was chaired by Marie- Claude Morice and included presentations by Stephan Windecker, Pawel Buszman, and Scot Garg that reviewed the long-term benefits of biodegradable polymers and the latest experience from the LEADERS trial. Data from Stephan Windecker highlighted the different efficacy and safety profiles of the new generation of drug-eluting stents (DES) so indicating that not all DES are equal, and nor are bare metal stents. Pawel Buszman presented data on the sirolimus eluting stent (SES) and the biolimus eluting stents (BES) and showed no difference in clinical outcome in patients with non-ST acute coronary syndrome (NST-ACS). In BES patients there was a significantly lower incidence of major adverse cardiac events (MACE) and cardiac death rate at 12 months compared with SES in the ST elevated myocardial infarction (STEMI) subgroup (p=0.02 and 0.04, respectively). This difference was due to an increased rate of subacute ST and target vessel revascularisation (TVR) during the first 30 days with SES. Scot Garg discussed the impact of stent design on outcome in patients with bifurcations who have a higher risk of MACE (p<0.05). When SES were compared with BES, significantly greater TVR and target lesion revascularisation (both p<0.05) were seen even though the overall MACE rate at 12 months was similar. Carlo Di Mario then discussed the lessons that can be learnt from optical From yesterday… coherence tomography and the ability of this to detect endothelial strut coverage and improved stent coverage with the biodegradable polymer.

In conclusion, LEADERS data presented was met with interest as these provide the first insight into the subgroup analyses. This session also introduced the next generation of stents – BES with biodegradable polymer and this was the first time that LEADERS data from STEMI and bifurcation subgroup analyses were presented. Attendees heard how patients with STEMI given a BES with biodegradable polymer were able to achieve superior results compared with patients given a SES, the current stent of choice in these patients. Bifurcation data presented were also met with considerable excitement. This is because these results show that BES with biodegradable polymers clearly provided improved patient outcomes. LEADER results show that overall this new stent is equivalent to a SES, but in subgroups like STEMI and patients with bifurcations, it is able to provide superior results. In addition, these data clearly demonstrated that a new second generation of stents exist and, once long-term data are available to confirm these results, we will have a new treatment option in patients with STEMI and bifurcations.