Preliminary Clinical Outcomes after Implantation of Newer-Generation Biodegradable Polymer-Coated Everolimus-Eluting Stent in “Real-World” Patients with Coronary Artery Disease

Background and Objective: In the contemporary practice, the use of drug-eluting stents is still associated with low mortality benefits, restenosis and stent thrombosis. To address these issues, newer generation, thin-strut, biodegradable polymer coated stents has been designed. Thus, the aim of the study is to assess the safety and clinical performance of the Everoflex (Sahajanand Medical Technologies Pvt. Ltd., Surat, India), a newer generation biodegradable polymer coated everolimus-eluting stent, in unselected “real-world” patients with coronary artery disease. Methods: It is a multicentre, retrospective, non-randomized, single-arm study enrolling all the consecutive patients who underwent implantation with the Everoflex for coronary artery disease from April 2014 to March 2016. The primary end-point of the study is 30-day major adverse cardiovascular events (MACE) rate, which consists of cardiac death, myocardial infarction, target lesion revascularization and target vessel revascularization. Stent thrombosis was also analyzed and reported. Results: A total of 340 patients were intervened successfully with 395 everolimus eluting stents (1.3 ± 0.6 stents per patient). Out of total patients (58.7 ± 10.5 years), 77.9% were male and comorbidities like diabetes and hypertension were observed in 31.2% and 35.3% patients, respectively. According to ACC/AHA classification, there were 34.4% type B lesions and 53.2% type C lesions, indicating a higher proportion of complexity involved. Moreover, 57.9% patients had multivessel disease and there were 15.4% total occlusions. At 30 days, follow-up was completed in 100% patients. The MACE was found to be 1.5%, which is a composite of 1.2% cardiac death and 0.3% target lesion revascularization. Stent thrombosis at 30 days was found to be 0.3%. Conclusion: The low incidence of MACE and stent thrombosis clearly depicts excellent safety and clinical performance of the Everoflex in unselected real world patients with coronary artery disease.

[1]  S. Hahn,et al.  Safety and efficacy of everolimus- versus sirolimus-eluting stents: a systematic review and meta-analysis of 11 randomized trials. , 2013, American heart journal.

[2]  P. Serruys,et al.  Stent Thrombosis With Everolimus-Eluting Stents: Meta-Analysis of Comparative Randomized Controlled Trials , 2012, Circulation. Cardiovascular interventions.

[3]  G. Stone,et al.  Stent thrombosis with drug-eluting and bare-metal stents: evidence from a comprehensive network meta-analysis , 2012, The Lancet.

[4]  Seung‐Jung Park,et al.  Everolimus-eluting versus sirolimus-eluting stents: an updated meta-analysis of randomized trials , 2012, Clinical Research in Cardiology.

[5]  Samin K. Sharma,et al.  Impact of the everolimus-eluting stent on stent thrombosis: a meta-analysis of 13 randomized trials. , 2011, Journal of the American College of Cardiology.

[6]  M. Zwahlen,et al.  Incidence and correlates of drug-eluting stent thrombosis in routine clinical practice. 4-year results from a large 2-institutional cohort study. , 2008, Journal of the American College of Cardiology.

[7]  M. Pfisterer,et al.  Drug eluting and bare metal stents in people with and without diabetes: collaborative network meta-analysis , 2008, BMJ : British Medical Journal.

[8]  P. Fitzgerald,et al.  Comparison of an everolimus-eluting stent and a paclitaxel-eluting stent in patients with coronary artery disease: a randomized trial. , 2008, JAMA.

[9]  Jeffrey L. Anderson,et al.  2007 Focused update of the ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. , 2008, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[10]  William Wijns,et al.  A Cause for Concern , 2007 .

[11]  Marco Valgimigli,et al.  Analysis of 14 trials comparing sirolimus-eluting stents with bare-metal stents. , 2007, The New England journal of medicine.

[12]  Masato Nakamura,et al.  Role of stent design and coatings on restenosis and thrombosis. , 2006, Advanced drug delivery reviews.

[13]  P. Fitzgerald,et al.  Six- and Twelve-Month Results From First Human Experience Using Everolimus-Eluting Stents With Bioabsorbable Polymer , 2004, Circulation.

[14]  C. Di Mario,et al.  In-stent restenosis in small coronary arteries: impact of strut thickness. , 2002, Journal of the American College of Cardiology.

[15]  M. Laberge,et al.  Effect of endovascular stent strut geometry on vascular injury, myointimal hyperplasia, and restenosis. , 2002, Journal of vascular surgery.

[16]  A. Kastrati,et al.  Intracoronary Stenting and Angiographic Results: Strut Thickness Effect on Restenosis Outcome (ISAR-STEREO) Trial , 2001, Circulation.

[17]  M. Schreier,et al.  SDZ RAD, a new rapamycin derivative: pharmacological properties in vitro and in vivo. , 1997, Transplantation.