STENTYS Self-Apposing® sirolimus-eluting stent in ST-segment elevation myocardial infarction: results from the randomised APPOSITION IV trial

Aims: We sought to investigate the impact of the self-apposing, sirolimus-eluting STENTYS stent on midterm and long-term stent apposition and strut coverage compared with a zotarolimus-eluting balloon expandable stent in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary per cutaneous coronary intervention (PPCI). Methods and results: In the APPOSITION IV trial, 152 STEMI patients were randomised (3:2) to the self-apposing, sirolimus-eluting STENTYS stent or a commercially available zotarolimus-eluting balloon expandable stent at 12 sites in five countries with angiographic follow--up and optical coherence tomography at four or nine months. At four months, a lower percentage of malapposed stent struts was observed in the STENTYS group (N=21; N1=501) compared with controls (N=26; N=326; 0.07% vs. 1.16%; p=0.002) with significantly more covered struts, using a 20 pm cut-off (94.32% vs. 89.09%; p=0.003). At nine months, the primary endpoint (percentage malapposed stein struts) was similar in both groups (STENTYS, N=40; N(strut)s=566; control, N=21; N-struts=292), showing complete apposition (p=0.55) and near total (>96%) coverage (p=0.58). Conclusions: In STEMI patients undergoing PPCI, the self-apposing, siro mms-eluting STENTYS stent was equivalent to a conventional dnig-eluting balloon-expandable stent with respect to late stent strut apposition and coverage at nine months. How-ever, stent strut apposition and coverage at four months were significantly better in the STENTYS group.