Introduction: The role of Biofreedom (polymer-free drug coated) stenting compared to coronary artery bypass graft (CABG) for coronary artery revascularization before elective surgery is unclear.
Hypothesis: Biofreedom stent might be associated with better outcomes than CABG.
Methods: Between January 2016 and Mar 2017, a total of 21 patients underwent percutaneous coronary intervention with Biofreedom stents before elective surgery (Biofreedom group) and 19 patients underwent CABG in the retrospective, multicenter cohort and we compared clinical outcomes between the Biofreedom group and CABG group. Primary outcomes were the period of planned operation after revascularization and the occurrence of the composite clinical endpoints (including death from any causes, myocardial infarction, stent thrombosis, stroke, any revascularization, or major bleeding).
Results: During follow-up (mean 276.2± 134.3 days), all patients of Biofreedom group underwent planned surgery without delay, but 73.7% of patients in CABG group underwent surgery (p=0.04). Comparing the time to planned surgery, the Biofreedom group showed a greater incidence of performing surgery within 45 days than with CABG (72.7 vs. 31.6%, p=0.02). The Biofreedom group maintained a shorter duration of dual antiplatelet therapy (DAPT) (32.0 ± 10.0 vs 97.8 ± 88.3, p=0.005). During the entire treatment period, incidence of major bleeding after revascularization was significantly lower in Biofreedom group than CABG group (0% vs. 36.8%, p=0.007). There were no occurrence of death or stent thrombosis in the Biofreedom group. The Biofreedom group showed a significantly lower occurrence of primary outcome (7.2% versus 54.8%, HR 0.11, 95% CI 0.01 to 0.93, p=0.01, mainly due to the lower incidence of major bleeding after intervention). However, the statistical significance was not reached when only the perioperative period was observed.
Conclusions: Biofreedom stent was associated with higher rate of performing planned surgery, shorter DAPT duration and lower incidence of major bleeding without increasing the risks of major cardiac event after surgery. In patients requiring coronary artery revascularization prior to elective surgery, Biofreedom stent might be a good treatment option.