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Leone PP, Assafin M, Scotti A, Gonzalez M, Mignatti A, Dawson K, Rauch J, Khaliq A, Bliagos D, Latib A. A technology evaluation of the Onyx Frontier drug-eluting stent. Expert Opin Drug Deliv 2023; 20:689-701. [PMID: 37203200 DOI: 10.1080/17425247.2023.2216449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 05/17/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Onyx FrontierTM represents the latest iteration within the family of zotarolimus-eluting stents (ZES), designed for the treatment of coronary artery disease. Approval by the Food and Drug Administration was granted in May 2022, and Conformité Européenne marking followed in August 2022. AREAS COVERED We hereby review the principal design features of Onyx Frontier, highlighting differences and similarities with other currently available drug-eluting stents. In addition, we focus on the refinements of this newest platform as compared with previous ZES versions, including the attributes yielding its exceptional crossing profile and deliverability. The clinical implications related to both its newest and inherited characteristics will be discussed. EXPERT OPINION The nuances of the latest Onyx Frontier, together with the continuous refinement previously witnessed throughout the development of ZES, lead to a latest generation device ideal for a diverse spectrum of clinical and anatomical scenarios. In particular, its peculiarities will be of benefit in the settings often offered by a progressively aging population, such as high bleeding risk patients and complex coronary lesions.
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Affiliation(s)
- Pier Pasquale Leone
- Division of Cardiology, Montefiore Medical Center, Bronx, NY, USA
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Manaf Assafin
- Division of Cardiology, Montefiore Medical Center, Bronx, NY, USA
| | - Andrea Scotti
- Division of Cardiology, Montefiore Medical Center, Bronx, NY, USA
| | - Maday Gonzalez
- Division of Cardiology, Montefiore Medical Center, Bronx, NY, USA
| | - Andrea Mignatti
- Division of Cardiology, Montefiore Medical Center, Bronx, NY, USA
| | - Kathryn Dawson
- Division of Cardiology, Montefiore Medical Center, Bronx, NY, USA
| | - Judah Rauch
- Division of Cardiology, Montefiore Medical Center, Bronx, NY, USA
| | - Asma Khaliq
- Division of Cardiology, Montefiore Medical Center, Bronx, NY, USA
| | | | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Bronx, NY, USA
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Ploumen EH, Pinxterhuis TH, Buiten RA, Zocca P, Danse PW, Schotborgh CE, Scholte M, Gin RMTJ, Somi S, van Houwelingen KG, Stoel MG, de Man HAF, Hartmann M, Linssen GCM, van der Heijden LC, Kok M, Doggen CJM, von Birgelen C. Final 5‐Year Report of the Randomized BIO‐RESORT Trial Comparing 3 Contemporary Drug‐Eluting Stents in All‐Comers. J Am Heart Assoc 2022; 11:e026041. [DOI: 10.1161/jaha.122.026041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background
In a previous trial, higher 5‐year mortality was observed following treatment with biodegradable polymer Orsiro sirolimus‐eluting stents (SES). We assessed 5‐year safety and efficacy of all‐comers as well as patients with diabetes treated with SES or Synergy everolimus‐eluting stents (EES) versus durable polymer Resolute Integrity zotarolimus‐eluting stents (ZES).
Methods and Results
The randomized BIO‐RESORT (Comparison of Biodegradable Polymer and Durable Polymer Drug‐Eluting Stents in an All Comers Population) trial enrolled 3514 all‐comer patients at 4 Dutch cardiac centers. Patients aged ≥18 years who required percutaneous coronary intervention were eligible. Participants were stratified for diabetes and randomized to treatment with SES, EES, or ZES (1:1:1). The main end point was target vessel failure (cardiac mortality, target vessel myocardial infarction, or target vessel revascularization). Five‐year follow‐up was available in 3183 of 3514 (90.6%) patients. The main end point target vessel failure occurred in 142 of 1169 (12.7%) patients treated with SES, 130 of 1172 (11.6%) treated with EES, versus 157 of 1173 (14.1%) treated with ZES (hazard ratio [HR], 0.89 [95% CI, 0.71–1.12],
P
log‐rank
=0.31; and HR, 0.82 [95% CI, 0.65–1.04],
P
log‐rank
=0.10, respectively). Individual components of target vessel failure showed no significant between‐stent difference. Very late definite stent thrombosis rates were low and similar (SES, 1.1%; EES, 0.6%; ZES, 0.9%). In patients with diabetes, target vessel failure did not differ significantly between stent‐groups (SES, 19.8%; EES, 19.2%; versus ZES, 21.1% [
P
log‐rank
=0.69 and
P
log‐rank
=0.63]).
Conclusions
Orsiro SES, Synergy EES, and Resolute Integrity ZES showed similar 5‐year outcomes of safety and efficacy, including mortality. A prespecified stent comparison in patients with diabetes also revealed no significant differences in 5‐year clinical outcomes.
Registration
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT01674803.
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Affiliation(s)
- Eline H. Ploumen
- Department of Cardiology Thoraxcentrum Twente, Medisch Spectrum Twente Enschede The Netherlands
- Department of Health Technology and Services Research, Faculty BMS Technical Medical Centre, University of Twente Enschede The Netherlands
| | - Tineke H. Pinxterhuis
- Department of Cardiology Thoraxcentrum Twente, Medisch Spectrum Twente Enschede The Netherlands
- Department of Health Technology and Services Research, Faculty BMS Technical Medical Centre, University of Twente Enschede The Netherlands
| | - Rosaly A. Buiten
- Department of Cardiology Thoraxcentrum Twente, Medisch Spectrum Twente Enschede The Netherlands
| | - Paolo Zocca
- Department of Cardiology Thoraxcentrum Twente, Medisch Spectrum Twente Enschede The Netherlands
| | - Peter W. Danse
- Department of Cardiology Rijnstate Hospital Arnhem The Netherlands
| | | | - Martijn Scholte
- Department of Cardiology Albert Schweitzer Hospital Dordrecht The Netherlands
| | | | - Samer Somi
- Department of Cardiology Haga Hospital The Hague The Netherlands
| | - K. Gert van Houwelingen
- Department of Cardiology Thoraxcentrum Twente, Medisch Spectrum Twente Enschede The Netherlands
| | - Martin G. Stoel
- Department of Cardiology Thoraxcentrum Twente, Medisch Spectrum Twente Enschede The Netherlands
| | - H. A. F. de Man
- Department of Cardiology Thoraxcentrum Twente, Medisch Spectrum Twente Enschede The Netherlands
| | - Marc Hartmann
- Department of Cardiology Thoraxcentrum Twente, Medisch Spectrum Twente Enschede The Netherlands
| | | | | | - Marlies M. Kok
- Department of Cardiology Thoraxcentrum Twente, Medisch Spectrum Twente Enschede The Netherlands
| | - Carine J. M. Doggen
- Department of Health Technology and Services Research, Faculty BMS Technical Medical Centre, University of Twente Enschede The Netherlands
| | - Clemens von Birgelen
- Department of Cardiology Thoraxcentrum Twente, Medisch Spectrum Twente Enschede The Netherlands
- Department of Health Technology and Services Research, Faculty BMS Technical Medical Centre, University of Twente Enschede The Netherlands
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Ploumen EH, von Birgelen C. Novel DES aims at full thromboresistance: Another promising player on the field? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 32:25-26. [PMID: 34391680 DOI: 10.1016/j.carrev.2021.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 07/29/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Eline H Ploumen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands; Department of Health Technology and Services Research, Faculty BMS, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Clemens von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands; Department of Health Technology and Services Research, Faculty BMS, Technical Medical Centre, University of Twente, Enschede, the Netherlands.
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Ploumen EH, Buiten RA, Zocca P, Doggen CJ, Aminian A, Schotborgh CE, Jessurun GA, Roguin A, Danse PW, Benit E, von Birgelen C. First Report of 3-Year Clinical Outcome After Treatment With Novel Resolute Onyx Stents in the Randomized BIONYX Trial. Circ J 2021; 85:1983-1990. [PMID: 34261828 DOI: 10.1253/circj.cj-21-0292] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND At 1 year, the international randomized BIONYX trial (ClinicalTrials.gov:NCT02508714) established non-inferiority regarding safety and efficacy of the novel Resolute Onyx zotarolimus-eluting stent (RO-ZES) vs. the Orsiro sirolimus-eluting stent (O-SES). Although the RO-ZES is used in daily practice, no clinical results have been published beyond 2 years.Methods and Results:We assessed 3-year clinical outcomes of 2,488 all-comers after percutaneous coronary intervention (PCI) with RO-ZES vs. O-SES. The main endpoint was target vessel failure (TVF), a composite of cardiac death, target vessel myocardial infarction (MI), or target vessel revascularization. Time-to-endpoints was assessed by Kaplan-Meier methods and between-group comparisons by log-rank tests. Follow-up was available in 2,433/2,488 (97.8%) patients. There was no significant between-stent difference in TVF (RO-ZES 112/1,243 [9.2%] vs. O-SES 109/1,245 [8.9%], hazard ratio [HR]: 1.03, 95% confidence interval [CI] 0.79-1.34; Plog-rank=0.85) and its individual components. The all-cause mortality was significantly lower after PCI with RO-ZES (3.7% vs.5.4%, HR: 0.67, 95% CI 0.46-0.97; Plog-rank=0.034), but cardiac mortality did not differ significantly (1.1% vs.1.9%, HR: 0.56, 95% CI 0.28-1.11; Plog-rank=0.09). Definite-or-probable stent thrombosis rates were low for both groups (0.6% vs.1.2%, HR: 0.46, 95% CI 0.19-1.14; Plog-rank=0.09). CONCLUSIONS This first 3-year randomized assessment of the RO-ZES showed a favorable rate of TVF that matched the outcomes of patients treated with O-SES. We observed a lower rate of all-cause death in the RO-ZES group, but long-term clinical follow-up is of interest.
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Affiliation(s)
- Eline H Ploumen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente.,Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente
| | - Rosaly A Buiten
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente.,Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente
| | - Paolo Zocca
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente
| | - Carine Jm Doggen
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi
| | | | | | - Ariel Roguin
- Department of Cardiology, Hillel Yaffe Medical Center.,B. Rappaport-Faculty of Medicine, Institute of Technology
| | | | | | - Clemens von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente.,Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente
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Ploumen EH, Buiten RA, Zocca P, Doggen CJM, Jessurun GAJ, Schotborgh CE, Roguin A, Danse PW, Benit E, Aminian A, Anthonio RL, Somi S, Linssen GCM, Hartmann M, Kok MM, von Birgelen C. Acute myocardial infarction treated with novel Resolute Onyx and Orsiro stents in the randomized BIONYX trial. Catheter Cardiovasc Interv 2021; 98:E188-E196. [PMID: 33694294 PMCID: PMC8451772 DOI: 10.1002/ccd.29594] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/01/2021] [Accepted: 02/19/2021] [Indexed: 01/23/2023]
Abstract
Objectives To compare 2‐year outcome following treatment with drug‐eluting stents (DES) for acute myocardial infarction (MI) versus non‐MI clinical syndromes. In acute MI patients, a stent‐level comparison was performed, comparing Resolute Onyx versus Orsiro stents. Background In patients presenting with acute MI, higher adverse event rates have been reported. So far, no clinical results >1 year have been published of acute MI patients treated with Resolute Onyx. Methods This post‐hoc analysis of the randomized BIONYX trial(NCT02508714) assessed the main outcome target vessel failure (TVF: cardiac death, target vessel MI, or target vessel revascularization) with Kaplan–Meier methods. Results Of all 2,488 trial participants, acute MI patients (n = 1,275[51.2%]) were significantly younger and had less comorbidities than non‐MI patients (n = 1,213[48.8%]). TVF rates were lower in acute MI patients (77/1,275[6.1%] vs. 103/1,213[8.6%], HR:0.70, 95%‐CI 0.52–0.94; plog‐rank = 0.02), mainly driven by target vessel revascularization (4.1 vs. 6.1%, plog‐rank = 0.03). Multivariate analysis showed no independent association of clinical syndrome with TVF (adjusted‐HR: 0.81, 95%‐CI 0.60–1.10; p = .17). In MI patients treated with Resolute Onyx (n = 626) versus Orsiro (n = 649), there was no difference in TVF (6.2 vs. 6.1%; plog‐rank = 0.97) and its components. There was only 1(0.2%) definite‐or‐probable stent thrombosis in RO‐ZES and 8(1.2%) in O‐SES (p = .053). Conclusions Two years after treatment with thin‐strut DES in this randomized trial, patients treated for acute MI had lower adverse event rates than non‐MI patients. Yet, these findings were mainly attributable to between‐group differences in patient and lesion characteristics. In patients who underwent PCI for acute MI, both Resolute Onyx and Orsiro showed favorable and similar 2‐year outcomes.
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Affiliation(s)
- Eline H Ploumen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands.,Department of Health Technology and Services Research, Faculty BMS, Technical Medical Center, University of Twente, Enschede, The Netherlands
| | - Rosaly A Buiten
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands.,Department of Health Technology and Services Research, Faculty BMS, Technical Medical Center, University of Twente, Enschede, The Netherlands
| | - Paolo Zocca
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Carine J M Doggen
- Department of Health Technology and Services Research, Faculty BMS, Technical Medical Center, University of Twente, Enschede, The Netherlands
| | - Gillian A J Jessurun
- Department of Cardiology, Treant Zorggroep, Scheper Hospital, Emmen, The Netherlands
| | | | - Ariel Roguin
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera and B. Rappaport-Faculty of Medicine, Israel, Institute of Technology, Haifa, Israel
| | - Peter W Danse
- Department of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Edouard Benit
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Rutger L Anthonio
- Department of Cardiology, Treant Zorggroep, Scheper Hospital, Emmen, The Netherlands
| | - Samer Somi
- Department of Cardiology, Haga Hospital, The Hague, The Netherlands
| | - Gerard C M Linssen
- Department of Cardiology, Hospital Group Twente, Almelo and Hengelo, Almelo, The Netherlands
| | - Marc Hartmann
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Marlies M Kok
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Clemens von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands.,Department of Health Technology and Services Research, Faculty BMS, Technical Medical Center, University of Twente, Enschede, The Netherlands
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