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, Masanori Taniwaki, MD Department of Cardiology, Tokorozawa Heart Center , Saitama , Japan Search for other works by this author on: Oxford Academic Jonas Dominik Häner, MD Department of Cardiology, Bern University Hospital, University of Bern , Bern , Switzerland Search for other works by this author on: Oxford Academic Ryota Kakizaki, MD, PhD Department of Cardiology, Bern University Hospital, University of Bern , Bern , Switzerland Search for other works by this author on: Oxford Academic Yohei Ohno, MD, PhD Department of Cardiology, Tokai University School of Medicine , Isehara , Japan Search for other works by this author on: Oxford Academic Kazuyuki Yahagi, MD Division of Cardiology, Mitsui Memorial Hospital , Tokyo , Japan Search for other works by this author on: Oxford Academic Yoshiharu Higuchi, MD, PhD Cardiovascular Division, Osaka Police Hospital , Osaka , Japan Search for other works by this author on: Oxford Academic George C M Siontis, MD, PhD Department of Cardiology, Bern University Hospital, University of Bern , Bern , Switzerland Search for other works by this author on: Oxford Academic Kenji Ando, MD, PhD Department of Cardiology, Kokura Memorial Hospital , f*ckuoka , Japan Search for other works by this author on: Oxford Academic Stefan Stortecky, MD MPH Department of Cardiology, Bern University Hospital, University of Bern , Bern , Switzerland Search for other works by this author on: Oxford Academic Nobuaki Suzuki, MD Division of Cardiology, Teikyo University Mizonokuchi Hospital , Kawasaki , Japan Search for other works by this author on: Oxford Academic
https://orcid.org/0000-0002-1420-8967 , Laura Morf, PhD Department of Cardiology, Bern University Hospital, University of Bern , Bern , Switzerland Search for other works by this author on: Oxford Academic Naoki Watanabe, MD, PhD Department of Cardiology, Ogaki Municipal Hospital , Gifu , Japan Search for other works by this author on: Oxford Academic Jonas Lanz, MD, MSc Department of Cardiology, Bern University Hospital, University of Bern , Bern , Switzerland Search for other works by this author on: Oxford Academic Yasushi Ueki, MD PhD Department of Cardiovascular Medicine, Shinshu University School of Medicine , Nagano , Japan Search for other works by this author on: Oxford Academic Tatsuhiko Otsuka, MD Department of Cardiology, Itabashi Chuo Medical Center , Tokyo , Japan Search for other works by this author on: Oxford Academic Flavio Giuseppe Biccirè, MD Department of Cardiology, Bern University Hospital, University of Bern , Bern , Switzerland Search for other works by this author on: Oxford Academic Masami Sakurada, MD, PhD Department of Cardiology, Tokorozawa Heart Center , Saitama , Japan Search for other works by this author on: Oxford Academic Sylvain Losdat, PhD CTU Bern, Department of Clinical Research, University of Bern , Bern , Switzerland Search for other works by this author on: Oxford Academic Lorenz Räber, MD, PhD Department of Cardiology, Bern University Hospital, University of Bern , Bern , Switzerland Corresponding author: Lorenz Räber, MD, PhD, Department of Cardiology, Bern University Hospital, Inselspital, 3010 Bern, Switzerland, lorenz.raeber@insel.ch Search for other works by this author on: Oxford Academic
Masanori Taniwaki, MD and Jonas Dominik Häner, MD contributed equally to this work.
Author Notes
European Heart Journal, ehae589, https://doi.org/10.1093/eurheartj/ehae589
Published:
01 September 2024
Article history
Received:
07 July 2024
Revision received:
13 August 2024
Published:
01 September 2024
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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, Long-term effect of biodegradable vs durable polymer everolimus-eluting stents on neoatherosclerosis in ST-segment elevation myocardial infarction: the CONNECT trial, European Heart Journal, 2024;, ehae589, https://doi.org/10.1093/eurheartj/ehae589
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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.
Structured Graphical Abstract
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Drug-eluting stent, biodegradable polymer, durable polymer, STEMI, neoatherosclerosis, optical coherence tomography
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Author notes
Masanori Taniwaki, MD and Jonas Dominik Häner, MD contributed equally to this work.
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.
This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/pages/standard-publication-reuse-rights)
Topic:
- stents
- st segment elevation myocardial infarction
- polymers
- everolimus
- drug-eluting stents
- extraperitoneal approach
- optical coherence tomography
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