Biolimus A9 polymer-free coated stents in high bleeding risk patients undergoing complex PCI: evidence from the LEADERS FREE randomised clinical trial.

Abstract

AIMS:

The LEADERS FREE trial has demonstrated that a polymer-free Biolimus A9-coated stent (BA9-DCS) is superior to a bare metal stent (BMS) for high bleeding risk (HBR) patients when treated with one month of dual antiplatelet therapy (DAPT). This analysis aimed to determine the impact of PCI procedure complexity on the two-year results.

METHODS AND RESULTS:

Six hundred and sixty-seven (667) patients enrolled in the LEADERS FREE (BA9-DCS 346, BMS 321) underwent a complex PCI, defined by one or more of eight characteristics: total stent length ≥60 mm, ≥3 vessels or lesions treated, ≥3 stents implanted, bifurcation lesion treated with ≥2 stents, chronically occluded, restenotic or saphenous vein graft lesion. Patients undergoing complex PCI were older, more often male, and presented with more ACS, diabetes, renal insufficiency, anaemia and multivessel disease. They derived major benefit from DCS over BMS for safety (16.2% vs. 21.7%, HR 0.70 [0.49-0.99], p<0.05) and for efficacy (10.8% vs. 18.1%, HR 0.54 [0.35-0.83], p<0.005). For the 1,746 patients with non-complex PCI, DCS demonstrated superior efficacy (5.3% vs. 9.9%, HR 0.52 [0.36-0.75], p<0.001, p for interaction NS) and similar safety to BMS (11.1% vs. 12.6%, NS, p for interaction NS).

CONCLUSIONS:

Compared to BMS, the BA9-DCS maintained both efficacy and safety benefits when used in complex PCI procedures.

• Authors: Janusz Lipiecki, Philippe Brunel, Marie-Claude Morice, Christan Roguelov, Simon J Walsh, Gert Richardt, Pedro Eerdmans, Robaayah Zambahari, Jacques Berland, Samuel Copt, Hans-Peter Stoll, Philip Urban
• Journal: EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology (EuroIntervention) Vol. 14 Issue 4 Pg. e418-e425 (Jul 20 2018) ISSN: 1969-6213 [Electronic] France
• PMID: 29790477 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Platelet Aggregation Inhibitors
• Polymers
• umirolimus
• Sirolimus

Topics

• Drug-Eluting Stents
• Humans
• Male
• Percutaneous Coronary Intervention
• Platelet Aggregation Inhibitors
• Polymers
• Sirolimus (analogs & derivatives)
• Treatment Outcome