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. 2022 Jul 27;108(16):1310-1318.
doi: 10.1136/heartjnl-2021-320116.

Outcomes and regional differences in practice in a worldwide coronary stent registry

Murat Cimci  1 , Jawed Polad  2 , Mamas Mamas  3   4 , Andres Iniguez-Romo  5 , Bernard Chevalier  6 , Rajpal Abhaichand  7 , Adel Aminian  8 , Ariel Roguin  9   10 , Gabriel Maluenda  11 , Michael Angioi  12 , Graham Cassel  13 , Shoichi Kuramitsu  14 , Lotte Jacobs  15 , Roxane Debrus  15 , Fazila Malik  16 , David Hildick-Smith  17 , Peep Laanmets  18 , Marco Roffi  19 ; e-ULTIMASTER investigators
Collaborators, Affiliations

Outcomes and regional differences in practice in a worldwide coronary stent registry

Murat Cimci et al. Heart. .

Abstract

Objective: The primary objective was to assess the performance of a new generation thin-strut sirolimus-eluting coronary stent with abluminal biodegradable polymer in an all comer population. The secondary objective was to detail differences in contemporary percutaneous coronary intervention (PCI) practice worldwide.

Methods: e-Ultimaster was an all-comer, prospective, global registry (NCT02188355) with independent event adjudication enrolling patients undergoing PCI with the study stent. The primary outcome measure was target lesion failure (TLF) at 1 year, defined as the composite of cardiac death, target vessel myocardial infarction and clinically driven target lesion revascularisation. Data were stratified according to 4 geographical regions.

Results: A total of 37 198 patients were enrolled (Europe 69.2%, Asia 17.8%, Africa/Middle East 6.6% and South America/Mexico 6.5%) and 1-year follow-up was available for 35 389 patients (95.1%). One-year TLF occurred in 3.2% of the patients, ranging from 2% (Africa/Middle East) to 4.1% (South America/Mexico). In patients with acute coronary syndrome, potent P2Y12 inhibitors were prescribed in 48% of patients at discharge, while at 1 year 72% were on any dual antiplatelet therapy. Lipid-lowering treatment was administered in 80.9% and 75.5% of patients at discharge and 1 year, respectively. Regional differences in the profile of the treated patients as well as in PCI practice were reported.

Conclusions: In this investigation with worldwide representation, contemporary PCI using a new generation thin-strut sirolimus-eluting coronary stent with abluminal biodegradable polymer was associated with low 1-year TLF across clinical presentations and continents. Suboptimal adherence to current recommendations around antiplatelet and lipid lowering treatments was detected.

Keywords: coronary artery disease; percutaneous coronary intervention.

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Conflict of interest statement

Competing interests: The following authors declare a competing interest with Terumo, the sponsor of the study: JP declared consulting fees; MM declared consulting fees and research grants; AA declared consulting fees; MA declared consulting fees; SK declared consulting fees; DJRH-S declared speaking fees and research grants; MR declared research grants. LJ and RD are employees of Terumo. All other authors have nothing to disclose.

Figures

Figure 1
Figure 1
Flow chart of the study population. The 1-year follow-up population included patients who had event that contributed to the primary outcome measure, died during follow-up or completed 1-year follow-up. DES, drug-eluting stent.
Figure 2
Figure 2
Radial access according to clinical presentation per region. CCS, chronic coronary syndrome; NSTE-ACS, non-ST-segment elevation acute coronary syndrome; STEMI, ST-segment elevation myocardial infarction.
Figure 3
Figure 3
Dual antiplatelet therapy at discharge and at follow-up according to clinical indication. ACS, acute coronary syndrome; CCS, chronic coronary syndrome; DAPT, dual antiplatelet therapy.
Figure 4
Figure 4
Lipid-lowering treatment in the overall patient population.
See this image and copyright information in PMC

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