title: Biodegradable polymer sirolimus-eluting stents versus durable polymer everolimus-eluting stents for primary percutaneous coronary revascularisation of acute myocardial infarction.
abstract: OBJECTIVE
  Our aim was to compare the safety and efficacy of a novel, ultrathin strut, biodegradable polymer sirolimus-eluting stent (BP-SES) with a thin strut, durable polymer everolimus-eluting stent (DP-EES) in a pre-specified subgroup of patients with acute ST-segment elevation myocardial infarction (STEMI) enrolled in the BIOSCIENCE trial.
  
  
  RESULTS
  The BIOSCIENCE trial is an investigator-initiated, single-blind, multicentre, randomised non-inferiority trial (NCT01443104). Randomisation was stratified according to the presence or absence of STEMI. The primary endpoint, target lesion failure (TLF), is a composite of cardiac death, target vessel myocardial infarction, and clinically indicated target lesion revascularisation within 12 months. Between February 2012 and May 2013, 407 STEMI patients were randomly assigned to treatment with BP-SES or DP-EES. At one year, TLF occurred in seven (3.4%) patients treated with BP-SES and 17 (8.8%) patients treated with DP-EES (RR 0.38, 95% CI: 0.16-0.91, p=0.024). Rates of cardiac death were 1.5% in the BP-SES group and 4.7% in the DP-EES group (RR 0.31, 95% CI: 0.08-1.14, p=0.062); rates of target vessel myocardial infarction were 0.5% and 2.6% (RR 0.18, 95% CI: 0.02-1.57, p=0.082), respectively, and rates of clinically indicated target lesion revascularisation were 1.5% in the BP-SES group versus 2.1% in the DP-EES group (RR 0.69, 95% CI: 0.16-3.10, p=0.631). There was no difference in the risk of definite stent thrombosis.
  
  
  CONCLUSIONS
  In this pre-specified subgroup analysis, BP-SES was associated with a lower rate of target lesion failure at one year compared to DP-EES in STEMI patients. These findings require confirmation in a dedicated STEMI trial.
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center, University Hospital, Bern, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Pilgrim
authors.forename: Raffaele
authors.initials: R
authors.lastname: Piccolo
authors.forename: Dik
authors.initials: D
authors.lastname: Heg
authors.forename: Marco
authors.initials: M
authors.lastname: Roffi
authors.forename: David
authors.initials: D
authors.lastname: Tüller
authors.forename: André
authors.initials: A
authors.lastname: Vuilliomenet
authors.forename: Olivier
authors.initials: O
authors.lastname: Muller
authors.forename: Stéphane
authors.initials: S
authors.lastname: Cook
authors.forename: Daniel
authors.initials: D
authors.lastname: Weilenmann
authors.forename: Christoph
authors.initials: C
authors.lastname: Kaiser
authors.forename: Peiman
authors.initials: P
authors.lastname: Jamshidi
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Khattab
authors.forename: Masanori
authors.initials: M
authors.lastname: Taniwaki
authors.forename: Fabio
authors.initials: F
authors.lastname: Rigamonti
authors.forename: Fabian
authors.initials: F
authors.lastname: Nietlispach
authors.forename: Stefan
authors.initials: S
authors.lastname: Blöchlinger
authors.forename: Peter
authors.initials: P
authors.lastname: Wenaweser
authors.forename: Peter
authors.initials: P
authors.lastname: Jüni
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
mesh_terms: D000368:Aged; D002317:Cardiovascular Agents / Q000627:therapeutic use; D003328:Coronary Thrombosis / Q000209:etiology / Q000628:therapy; D054855:Drug-Eluting Stents; D000068338:Everolimus / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D016037:Single-Blind Method; D020123:Sirolimus / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D000068338:Everolimus; D020123:Sirolimus