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Stent Selection for Primary Angioplasty and Outcomes in the Era of Potent Antiplatelets. Data from the Multicenter Randomized Prague-18 Trial

O. Hlinomaz, Z. Motovska, J. Knot, R. Miklik, M. Sabbah, M. Hromadka, I. Varvarovsky, J. Dusek, M. Svoboda, F. Tousek, B. Majtan, S. Simek, M. Branny, J. Jarkovský

. 2021 ; 10 (21) : . [pub] 20211030

Language English Country Switzerland

Document type Journal Article

Persistent link   https://www.medvik.cz/link/bmc22001415

Grant support
Progress Q 38 Charles University

Drug-eluting stents (DES) are the recommended stents for primary percutaneous coronary intervention (PCI). This study aimed to determine why interventional cardiologists used non-DES and how it influenced patient prognoses. The efficacy and safety outcomes of the different stents were also compared in patients treated with either prasugrel or ticagrelor. Of the PRAGUE-18 study patients, 749 (67.4%) were treated with DES, 296 (26.6%) with bare-metal stents (BMS), and 66 (5.9%) with bioabsorbable vascular scaffold/stents (BVS) between 2013 and 2016. Cardiogenic shock at presentation, left main coronary artery disease, especially as the culprit lesion, and right coronary artery stenosis were the reasons for selecting a BMS. The incidence of the primary composite net-clinical endpoint (EP) (death, nonfatal myocardial infarction, stroke, serious bleeding, or revascularization) at seven days was 2.5% vs. 6.3% and 3.0% in the DES, vs. with BMS and BVS, respectively (HR 2.7; 95% CI 1.419-5.15, p = 0.002 for BMS vs. DES and 1.25 (0.29-5.39) p = 0.76 for BVS vs. DES). Patients with BMS were at higher risk of death at 30 days (HR 2.20; 95% CI 1.01-4.76; for BMS vs. DES, p = 0.045) and at one year (HR 2.1; 95% CI 1.19-3.69; p = 0.01); they also had a higher composite of cardiac death, reinfarction, and stroke (HR 1.66; 95% CI 1.0-2.74; p = 0.047) at one year. BMS were associated with a significantly higher rate of primary EP whether treated with prasugrel or ticagrelor. In conclusion, patients with the highest initial risk profile were preferably treated with BMS over BVS. BMS were associated with a significantly higher rate of cardiovascular events whether treated with prasugrel or ticagrelor.

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$a Hlinomaz, Ota $u ICRC, Department of Cardioangiology, St. Anne University Hospital, Masaryk University, 65691 Brno, Czech Republic
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$a Drug-eluting stents (DES) are the recommended stents for primary percutaneous coronary intervention (PCI). This study aimed to determine why interventional cardiologists used non-DES and how it influenced patient prognoses. The efficacy and safety outcomes of the different stents were also compared in patients treated with either prasugrel or ticagrelor. Of the PRAGUE-18 study patients, 749 (67.4%) were treated with DES, 296 (26.6%) with bare-metal stents (BMS), and 66 (5.9%) with bioabsorbable vascular scaffold/stents (BVS) between 2013 and 2016. Cardiogenic shock at presentation, left main coronary artery disease, especially as the culprit lesion, and right coronary artery stenosis were the reasons for selecting a BMS. The incidence of the primary composite net-clinical endpoint (EP) (death, nonfatal myocardial infarction, stroke, serious bleeding, or revascularization) at seven days was 2.5% vs. 6.3% and 3.0% in the DES, vs. with BMS and BVS, respectively (HR 2.7; 95% CI 1.419-5.15, p = 0.002 for BMS vs. DES and 1.25 (0.29-5.39) p = 0.76 for BVS vs. DES). Patients with BMS were at higher risk of death at 30 days (HR 2.20; 95% CI 1.01-4.76; for BMS vs. DES, p = 0.045) and at one year (HR 2.1; 95% CI 1.19-3.69; p = 0.01); they also had a higher composite of cardiac death, reinfarction, and stroke (HR 1.66; 95% CI 1.0-2.74; p = 0.047) at one year. BMS were associated with a significantly higher rate of primary EP whether treated with prasugrel or ticagrelor. In conclusion, patients with the highest initial risk profile were preferably treated with BMS over BVS. BMS were associated with a significantly higher rate of cardiovascular events whether treated with prasugrel or ticagrelor.
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$a Motovska, Zuzana $u Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Cardiocentre, 10034 Prague, Czech Republic
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$a Knot, Jiri $u Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Cardiocentre, 10034 Prague, Czech Republic
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$a Miklik, Roman $u Department of Internal Medicine and Cardiology, Faculty of Medicine of Masaryk University and University Hospital, 62500 Brno, Czech Republic
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$a Sabbah, Mahmoud $u ICRC, Department of Cardioangiology, St. Anne University Hospital, Masaryk University, 65691 Brno, Czech Republic $u Faculty of Medicine, Suez Canal University, Ismailia P.O. Box 41522, Egypt
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$a Hromadka, Milan $u Department of Cardiology, University Hospital and Faculty of Medicine, Charles University, 30599 Pilsen, Czech Republic
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$a Varvarovsky, Ivo $u Cardiology Centre AGEL, 53203 Pardubice, Czech Republic
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$a Dusek, Jaroslav $u First Department of Internal Medicine, University Hospital Hradec Kralove, 50005 Hradec Kralove, Czech Republic
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$a Svoboda, Michal $u Faculty of Medicine, Institute of Biostatistics and Analyses, Masaryk University, 62500 Brno, Czech Republic
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$a Tousek, Frantisek $u Cardiocentre-Department of Cardiology, Regional Hospital, 37001 Ceske Budejovice, Czech Republic
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$a Majtan, Bohumil $u Cardiocentre, Regional Hospital, 36001 Karlovy Vary, Czech Republic
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$a Simek, Stanislav $u Department of Physiology and Second Department of Medicine-Department of Cardiovascular Medicine, 1st Faculty of Medicine, Charles University, 12808 Prague, Czech Republic
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$a Branny, Marian $u Cardiovascular Center, Hospital Podlesi, AGEL Research and Training Institute, 73961 Trinec, Czech Republic
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$a Jarkovský, Jiří $u Faculty of Medicine, Institute of Biostatistics and Analyses, Masaryk University, 62500 Brno, Czech Republic
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