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7 Initial experience of bioabsorbable polymer everolimus-eluting stents in high risk patients
  1. R Noad1,
  2. C Hanratty2,
  3. S Walsh2
  1. 1Belfast Trust, Belfast, UK
  2. 2Belfast Health & Social Care, Belfast, UK

Abstract

Aims As progressively more elderly and comorbid patients are being considered for revascularisation the need for one year of dual anti-platelets becomes of increasing concern. SYNERGY Everolimus-eluting platinum chromium coronary stents allow for early cessation of dual antiplatelet therapy (DAPT) due to complete polymer absorption and drug elution by three months. The aim of this study was to retrospectively assess those in our unit who have underwent PCI with a SYNERGY stent to look for adverse outcomes post-discontinuation of DAPT.

Methods All patients in our unit who underwent clinically indicated PCI with a SYNERGY stent from August 2013–December 2014 were retrospectively analysed. Baseline and procedural characteristics were recorded. Follow-up was by review of medical records or telephone contact for post-procedural complications or adverse events.

Results In total 100 patients underwent PCI with a SYNERGY during the one-year study period. The mean age was 72.3 years (10.0; range 41–92 years), 37% of the cohort was defined as elderly (age >75 years) and 8% defined as very elderly (age >85 years). Mean EuroSCORE was 11.37 (11.13, range 0.88–70.23). The indication for SYNERGY stent use was as follows; frail or elderly (16%), concurrent anticoagulation (28%) need for a non-cardiac procedure (10%), increased bleeding risk (31%), or other (15%). NSTEMI/STEMI was the presenting complaint in 32% of patients. The coronary disease was complex. Left main stem was involved in (13%), multi-vessel disease (36%), bifurcation disease requiring side-branch stenting (9%), and 37% required CTO intervention. Mean Syntax score was 22.7 (12.1, range 6–53). The mean stent length/ patient was 75.3 mm (41.5) with 1.44 (0.64) lesions treated and 2.67 (1.33) stents implanted per patient. DAPT discontinuation by 3 months has occurred in 52% to date (planned in 77%).

Despite the patient and lesion complexity, there were no thrombotic events after discontinuation of anti-platelets (acute, sub-acute or late stent thrombosis). Eight patients were able to undergo non-cardiac surgery after three months DAPT. By a maximum of six months four patients died from non-cardiac causes (one from cancer, one sepsis and multi-organ failure, one ruptured abdominal aortic aneurysm and one vascular complication post-TAVI).

There was one target vessel revascularisation by the same time-point. Full outcome data will be available for presentation at the conference.

Conclusion The use of SYNERGY stents allows early discontinuation of DAPT, reducing the risk of bleeding complications and facilitating non-cardiac procedures, without an increase in the incidence of sub-acute thrombosis in complex coronary disease and a high-risk population.

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