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OBJECTIVES: This study sought to report the final 5 years follow-up of the landmark LEADERS (Limus Eluted From A Durable Versus ERodable Stent Coating) trial. BACKGROUND: The LEADERS trial is the first randomized study to evaluate biodegradable polymer-based drug-eluting stents (DES) against durable polymer DES. METHODS: The LEADERS trial was a 10-center, assessor-blind, noninferiority, "all-comers" trial (N = 1,707). All patients were centrally randomized to treatment with either biodegradable polymer biolimus-eluting stents (BES) (n = 857) or durable polymer sirolimus-eluting stents (SES) (n = 850). The primary endpoint was a composite of cardiac death, myocardial infarction (MI), or clinically indicated target vessel revascularization within 9 months. Secondary endpoints included extending the primary endpoint to 5 years and stent thrombosis (ST) (Academic Research Consortium definition). Analysis was by intention to treat. RESULTS: At 5 years, the BES was noninferior to SES for the primary endpoint (186 [22.3%] vs. 216 [26.1%], rate ratio [RR]: 0.83 [95% confidence interval (CI): 0.68 to 1.02], p for noninferiority <0.0001, p for superiority = 0.069). The BES was associated with a significant reduction in the more comprehensive patient-orientated composite endpoint of all-cause death, any MI, and all-cause revascularization (297 [35.1%] vs. 339 [40.4%], RR: 0.84 [95% CI: 0.71 to 0.98], p for superiority = 0.023). A significant reduction in very late definite ST from 1 to 5 years was evident with the BES (n = 5 [0.7%] vs. n = 19 [2.5%], RR: 0.26 [95% CI: 0.10 to 0.68], p = 0.003), corresponding to a significant reduction in ST-associated clinical events (primary endpoint) over the same time period (n = 3 of 749 vs. n = 14 of 738, RR: 0.20 [95% CI: 0.06 to 0.71], p = 0.005). CONCLUSIONS: The safety benefit of the biodegradable polymer BES, compared with the durable polymer SES, was related to a significant reduction in very late ST (>1 year) and associated composite clinical outcomes. (Limus Eluted From A Durable Versus ERodable Stent Coating [LEADERS] trial; NCT00389220).

Original publication

DOI

10.1016/j.jcin.2013.04.011

Type

Journal article

Journal

JACC Cardiovasc Interv

Publication Date

08/2013

Volume

6

Pages

777 - 789

Keywords

ACS, ARC, Academic Research Consortium, BES, BMS, CI, DES, KM, Kaplan-Meier, MACE, MI, PCI, POCE, RR, SES, ST, ST-segment elevation myocardial infarction, STEMI, TVR, acute coronary syndrome, bare-metal stent(s), biodegradable polymer, biolimus-eluting stent(s), confidence interval, drug-eluting stent(s), drug-eluting stents, durable polymer, major adverse cardiac events, myocardial infarction, patient-oriented composite endpoint, percutaneous coronary intervention, rate ratio(s), sirolimus-eluting stent(s), stent thrombosis, target vessel revascularization, Absorbable Implants, Aged, Cardiovascular Agents, Chi-Square Distribution, Coronary Artery Disease, Coronary Thrombosis, Drug-Eluting Stents, Europe, Female, Humans, Intention to Treat Analysis, Kaplan-Meier Estimate, Male, Middle Aged, Myocardial Infarction, Odds Ratio, Percutaneous Coronary Intervention, Polymers, Proportional Hazards Models, Prospective Studies, Prosthesis Design, Risk Factors, Sirolimus, Time Factors, Treatment Outcome