Long-term effect of biodegradable vs durable polymer everolimus-eluting stents on neoatherosclerosis in ST-segment elevation myocardial infarction: the CONNECT trial

Masanori Taniwaki; Jonas Dominik Häner; Ryota Kakizaki; Yohei Ohno; Kazuyuki Yahagi; Yoshiharu Higuchi; George C M Siontis; Kenji Ando; Stefan Stortecky; Nobuaki Suzuki; Laura Morf; Naoki Watanabe; Jonas Lanz; Yasushi Ueki; Tatsuhiko Otsuka; Flavio Giuseppe Biccirè; Masami Sakurada; Sylvain Losdat; Lorenz Räber

doi:10.1093/eurheartj/ehae589

Long-term effect of biodegradable vs durable polymer everolimus-eluting stents on neoatherosclerosis in ST-segment elevation myocardial infarction: the CONNECT trial

Eur Heart J. 2024 Sep 1:ehae589. doi: 10.1093/eurheartj/ehae589. Online ahead of print.

Authors

Masanori Taniwaki¹, Jonas Dominik Häner², Ryota Kakizaki², Yohei Ohno³, Kazuyuki Yahagi⁴, Yoshiharu Higuchi⁵, George C M Siontis², Kenji Ando⁶, Stefan Stortecky², Nobuaki Suzuki⁷, Laura Morf², Naoki Watanabe⁸, Jonas Lanz², Yasushi Ueki⁹, Tatsuhiko Otsuka¹⁰, Flavio Giuseppe Biccirè², Masami Sakurada¹, Sylvain Losdat¹¹, Lorenz Räber²

Affiliations

¹ Department of Cardiology, Tokorozawa Heart Center, Saitama, Japan.
² Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.
³ Department of Cardiology, Tokai University School of Medicine, Isehara, Japan.
⁴ Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan.
⁵ Cardiovascular Division, Osaka Police Hospital, Osaka, Japan.
⁶ Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan.
⁷ Division of Cardiology, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan.
⁸ Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan.
⁹ Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan.
¹⁰ Department of Cardiology, Itabashi Chuo Medical Center, Tokyo, Japan.
¹¹ CTU Bern, Department of Clinical Research, University of Bern, Bern, Switzerland.

PMID: 39217617
DOI: 10.1093/eurheartj/ehae589

Abstract

Background and aims: Neoatherosclerosis is a leading cause of late (>1 year) stent failure following drug-eluting stent implantation. The role of biodegradable (BP) versus durable polymer (DP) drug-eluting stents on long-term occurrence of neoatherosclerosis remains unclear. Superiority of biodegradable against durable polymer current generation thin-strut everolimus-eluting stent (EES) was tested by assessing the frequency of neoatherosclerosis 3 years after primary percutaneous coronary intervention (pPCI) among patients with ST-segment elevation myocardial infarction (STEMI).

Methods: The randomized controlled, multicentre (Japan and Switzerland) CONNECT trial (NCT03440801) randomly (1:1) assigned 239 STEMI patients to pPCI with BP-EES or DP-EES. The primary endpoint was the frequency of neoatherosclerosis assessed by optical coherence tomography (OCT) at 3 years. Neoatherosclerosis was defined as fibroatheroma or fibrocalcific plaque or macrophage accumulation within the neointima.

Results: Among 239 STEMI patients randomized, 236 received pPCI with stent implantation (119 BP-EES; 117 DP-EES). A total of 178 patients (75%; 88 in the BP-EES group and 90 in the DP-EES group) underwent OCT assessment at 3 years. Neoatherosclerosis did not differ between the BP-EES (11.4%) and DP-EES (13.3%; odds ratio 0.83, 95% confidence interval 0.33-2.04, p=0.69). There were no differences in the frequency of fibroatheroma (BP-EES 9.1% vs DP-EES 11.1%, p=0.66) or macrophage accumulation (BP-EES 4.5% vs DP-EES 3.3%, p=0.68), and no fibrocalcific neoatherosclerosis was observed. Rates of target lesion failure did not differ between groups (BP-EES 5.9% vs DP-EES 6.0%, p=0.97).

Conclusions: Use of BP-EES for primary PCI in patients presenting with STEMI was not superior to DP-EES regarding frequency of neoatherosclerosis at 3 years.

Keywords: Drug-eluting stent; STEMI; biodegradable polymer; durable polymer; neoatherosclerosis; optical coherence tomography.

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