Micell Technologies has announced positive twelve-month data from its DESSOLVE III clinical trial comparing the company’s MiStent with Abbott’s Xience. The study met its primary endpoint, showing non-inferior safety and effectiveness outcomes in a complex patient population for the MiStent sirolimus-eluting absorbable polymer coronary stent system vs. the Xience everolimus-eluting coronary stent system. Robbert J de Winter, Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands, presented the data at EuroPCR 2017.
De Winter commented, “MiStent met the primary non-inferiority endpoint of target lesion failure (TLF) at 12 months, with numerically lower TLF and target lesion revascularisation (TLR) rates. TLR rates for MiStent were numerically lower at all time points following the procedure, and by one year that difference grew to 1.2%. These results speak to the potential value of slower, controlled drug release allowing for sustained drug presence. These trial results, in conjunction with the five-year results from the DESSOLVE I and II studies, provide further evidence of the potential value of this technology relative to current DES performance expectations from the perspectives of both safety and efficacy.”
DESSOLVE III is a prospective, balanced, randomised, controlled, single-blind, multicentre all-comers study comprising 1,400 patients. Enrolment was completed in December 2015, and this presentation highlighted twelve-month primary endpoint outcomes. The study is being conducted independently by the European Cardiovascular Research Institute, Rotterdam, The Netherlands, and is supported by Micell Technologies. The study design and conduct were overseen by a steering committee including Patrick Serruys (Rotterdam, The Netherlands), de Winter, and William Wijns (Galway, Ireland).
Patients in this trial suffered from symptomatic coronary artery disease, including those with chronic stable angina, silent ischaemia, or acute coronary syndrome (including non-ST-elevation myocardial infarction and ST-elevation myocardial infarction), and qualified for percutaneous coronary interventions. The primary endpoint for this trial was a non-inferiority comparison of TLF for the MiStent group versus the Xience group at 12 months post-procedure.
In a session on novel drug-eluting stent technologies, Krzysztof Milewski, lead investigator for the DESSOLVE III OCT sub-study, highlighted positive outcomes from assessments of optical coherence tomography (OCT) images from MiStent and Xience patients at six months. Neointimal hyperplasia volume obstruction was statistically lower for MiStent (15.0±4.1% vs 18.9±6.2%; p<0.01). Similarly, both abluminal neointimal hyperplasia volume and area were significantly better with MiStent by 13.3 mm3 (p=0.02) and 0.33 mm2 (p<0.01), respectively. Both groups demonstrated equal and almost complete strut coverage.
“We observed a statistically significant difference in favour of MiStent,” confirms Milewski, general director, Center for Research and Development for the American Heart of Poland S.A. “These OCT data further demonstrate that the unique pharmacokinetics of MiStent, with its micro-crystalline sirolimus, reduce the factors that lead to late lumen loss requiring vessel revascularisation.”
Additional data and an overview of the rationale and design of the OCT assessments were also presented by Milewski during a late-breaking trial at EuroPCR. Milewski will present, “OCT and IVUS Imaging for Evaluation of Stent-Based Therapies: DESSOLVE III, a Randomised OCT Sub-Study Comparison of Xience vs MiStent.”