Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access
Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc
Journal website https://cr.elmerpub.com

Original Article

Volume 15, Number 6, December 2024, pages 439-452


Safety and Efficacy of BioMime Sirolimus-Eluting Stent System in All-Comers Real-World Population With Coronary Artery Stenosis: MILES Global Registry

Figure

Figure 1.
Figure 1. Patient disposition.

Tables

Table 1. Patient Demographics and Baseline Clinical Characteristics
 
ParameterTotal sample (N = 771)Stent length > 30 mm (n = 253)Stent diameter 4 and 4.5 mm (n = 49)Subjects with bifurcation lesions (n = 82)Subjects with CTO (n = 127)
CTO: chronic total occlusion; SD: standard deviation.
Age, years, mean ± SD64.15 ± 10.9563.05 ± 11.0464.57 ± 12.4264.87 ± 10.3362.86 ± 10.68
Male, n (%)576 (74.71)189 (74.70)39 (79.59)64 (78.05)98 (77.17)
Body mass index, kg/m2, mean ± SD26.84 ± 4.4226.88 ± 4.5527.92 ± 4.1126.60 ± 4.0026.11 ± 4.36
Systolic blood pressure, mm Hg, mean ± SD132.54 ± 21.68134.14 ± 22.20134.14 ± 24.21135.23 ± 23.27129.18 ± 22.52
Diastolic blood pressure, mm Hg, mean ± SD77.10 ± 12.8276.82 ± 12.7679.55 ± 11.4479.12 ± 13.0876.84 ± 14.91
Heart rate, bpm, mean ± SD72.74 ± 12.7370.92 ± 11.8271.63 ± 9.8674.88 ± 13.3772.91 ± 13.65
Medical history, n (%)n = 771n = 253n = 49n = 82n = 127
  Family history of cardiovascular disease209 (27.11)69 (27.27)17 (34.69)24 (29.27)36 (28.35)
  Smokers364 (47.21)78 (30.83)21 (42.86)21 (25.61)56 (44.09)
  Alcoholic132 (17.12)39 (15.42)13 (26.53)17 (20.73)23 (18.11)
  Diabetes mellitus207 (26.85)81 (32.02)5 (10.20)22 (26.83)33 (25.98)
  Dyslipidemia391 (50.71)130 (51.38)20 (40.82)40 (48.78)52 (40.94)
  Anemia10 (1.30)5 (1.98)-2 (2.44)2 (1.57)
  Liver disease14 (1.82)3 (1.19)-1 (1.22)2 (1.57)
  Hypertension490 (63.55)171 (67.59)28 (57.14)49 (59.76)75 (59.06)
  Renal insufficiency36 (4.67)16 (6.32)3 (6.12)5 (6.10)4 (3.15)
  Chronic lung disease43 (5.58)16 (6.32)4 (8.16)7 (8.54)9 (7.09)
  Peripheral vascular disease30 (3.89)13 (5.14)5 (10.20)3 (3.66)2 (1.57)
  Other illness137 (17.77)39 (15.42)11 (22.45)22 (26.83)26 (20.47)
Cardiovascular history, n (%)n = 771n = 253n = 49n = 82n = 127
  History of stroke33 (4.28)11 (4.35)21 (42.86)3 (3.66)4 (3.15)
  Cardiovascular disease139 (18.03)58 (22.92)6 (12.24)16 (19.51)20 (15.75)
  Transient ischemic attack6 (0.78)1 (0.40)0 (0)1 (1.22)1 (0.79)
  History of previous myocardial infarction118 (15.3)42 (16.60)7 (14.29)11 (13.41)15 (11.81)
  History of percutaneous coronary intervention100 (12.97)34 (13.44)6 (12.24)10 (12.20)13 (10.24)
  History of coronary artery bypass graft surgery3 (0.39)2 (0.79)0 (0)1 (1.22)0 (0)
  Others48 (6.23)13 (5.14)3 (6.12)3 (3.66)5 (3.94)
Current angina, n (%)n = 765n = 251n = 49n = 81n = 126
  Stable235 (30.71)78 (31.08)14 (28.57)25 (30.86)25 (19.84)
  Unstable363 (47.45)116 (46.22)27 (55.10)40 (49.38)60 (47.62)
  Not applicable167 (21.83)57 (22.71)8 (16.33)16 (19.75)41 (32.54)

 

Table 2. Lesion Characteristics
 
CharacteristicsTotal sample (N = 771)Stent length > 30 mm (n = 253)Stent diameter 4 and 4.5 mm (n = 49)Subjects with bifurcation lesions (n = 82)Subjects with CTO (n = 127)
ACC: American College of Cardiology; AHA: American Heart Association; CTO: chronic total occlusion; TIMI: thrombolysis in myocardial infarction.
Total number of treatable lesions, n1,0792784991141
Diseased vessel, n (%)n = 755n = 250n = 48n = 80n = 126
  Single vessel486 (64.37)146 (58.40)32 (66.67)37 (46.25)68 (53.97)
  Double vessel183 (24.24)67 (26.80)9 (18.75)26 (32.5)40 (31.75)
  Triple vessel or more86 (11.39)37 (14.80)7 (14.58)17 (21.25)18 (14.29)
Lesion location, n (%)n = 1,079n = 278n = 49n = 91n = 141
  Left main6 (0.56)0 (0)0 (0)2 (2.2)0 (0)
  Right coronary artery309 (28.64)109 (39.21)31 (63.27)12 (13.19)56 (39.72)
  Left anterior descending458 (42.45)117 (42.09)17 (34.69)51 (56.04)47 (33.33)
  Left circumflex169 (15.66)43 (15.47)1 (2.04)19 (20.88)24 (17.02)
  Diagonal36 (3.34)0 (0)0 (0)5 (5.49)6 (4.26)
  Obtuse marginal54 (5)9 (3.24)0 (0)0 (0)4 (2.84)
  Posterior descending17 (1.58)0 (0)0 (0)2 (2.2)4 (2.84)
  Intermediate/anterolateral17 (1.58)0 (0)0 (0)0 (0)0 (0)
  Others13 (1.2)0 (0)0 (0)0 (0)0 (0)
Type of stenosis, n (%)n = 1,067n = 274n = 49n = 91n = 141
  De novo1,049 (98.31)264 (96.35)48 (97.96)80 (87.91)139 (98.58)
  In-stent9 (0.84)6 (2.19)1 (2.04)2 (2.2)1 (0.71)
  Bifurcation9 (0.84)4 (1.46)0 (0)9 (9.89)1 (0.71)
Thrombus load, n (%)n = 1,067n = 269n = 49n = 91n = 141
  None858 (80.41)190 (70.63)35 (71.43)69 (75.82)75 (53.19)
  Mild74 (6.94)25 (9.29)6 (12.24)7 (7.69)13 (9.22)
  Moderate95 (8.9)40 (14.87)5 (10.2)10 (10.99)26 (18.44)
  Severe40 (3.75)14 (5.2)3 (6.12)5 (5.49)27 (19.15)
ACC/AHA type, n (%)n = 1,067n = 272n = 49n = 91n = 141
  A164 (15.37)31 (11.4)5 (10.2)11 (12.09)6 (4.26)
  B1403 (37.77)92 (33.82)18 (36.73)28 (30.77)27 (19.15)
  B2265 (24.84)63 (23.16)15 (30.61)21 (23.08)34 (24.11)
  C235 (22.02)86 (31.62)11 (22.45)31 (34.07)74 (52.48)
Morphology, n (%)n = 1,064n = 273n = 49n = 91n = 141
  Concentric556 (52.26)151 (55.31)31 (63.27)54 (59.34)75 (53.57)
  Eccentric508 (47.74)122 (44.69)18 (36.73)37 (40.66)65 (46.43)
TIMI flow prior to treatment, n (%)n = 1,078n = 274n = 49n = 91n = 141
  TIMI 0157 (14.56)62 (22.63)5 (10.2)14 (15.38)118 (83.69)
  TIMI 172 (6.68)30 (10.95)1 (2.04)4 (4.4)6 (4.26)
  TIMI 2191 (17.72)50 (18.25)12 (24.49)14 (15.38)7 (4.96)
  TIMI 3658 (61.04)132 (48.18)31 (63.27)59 (64.84)10 (7.09)
TIMI flow post-procedure, n (%)n = 1,040n = 278n = 49n = 84n = 132
  TIMI 06 (0.58)2 (0.72)0 (0)2 (2.38)4 (3.03)
  TIMI 15 (0.48)1 (0.36)0 (0)0 (0)4 (3.03)
  TIMI 225 (2.4)5 (1.8)2 (4.08)0 (0)4 (3.03)
  TIMI 31,004 (96.54)270 (97.12)47 (95.92)82 (97.62)120 (90.91)
  Total occlusion, n (%)141/1,067 (13.21)45/101 (44.55)48/49 (97.96)13/91 (14.29)141/141 (100)
Tortuosity of lesion, n (%)n = 1,067n = 273n = 49n = 91n = 141
  Mild784 (73.48)197 (72.16)43 (87.76)66 (72.53)104 (73.76)
  Moderate217 (20.34)59 (21.61)6 (12.24)20 (21.98)12 (8.51)
  Severe66 (6.19)17 (6.23)0 (0)5 (5.49)25 (17.73)
Lesion calcification, n (%)n = 1,067n = 273n = 49n = 91n = 141
  Mild634 (59.42)149 (54.58)30 (61.22)57 (62.64)81 (57.45)
  Moderate217 (20.34)70 (25.64)8 (16.33)16 (17.58)20 (14.18)
  Severe47 (4.4)24 (8.79)4 (8.16)8 (8.79)6 (4.26)
  Not applicable169 (15.84)205 (73.74)7 (14.29)10 (10.99)34 (24.11)

 

Table 3. Procedural Characteristics
 
Procedural characteristicsTotal sample (N = 771)Stent length > 30 mm (n = 253)Stent diameter 4 and 4.5 mm (n = 49)Subjects with bifurcation lesions (n = 82)Subjects with CTO (n = 127)
CTO: chronic total occlusion; SD: standard deviation.
Lesion pre-dilatation done, n (%)599 (55.51)205 (73.74)39 (79.59)73 (80.22)94 (66.67)
Lesion length, mm, mean ± SD, (n = 1,075)22.75 ± 12.2234.61 ± 12.7216.04 ± 6.9521.32 ± 10.2225.16 ± 9.49
Stent length, mm, n (%)n = 1,039n = 278n = 52n = 84n = 132
  810 (0.96)0 (0)0 (0)1 (1.19)0 (0)
  1382 (7.89)0 (0)6 (11.54)8 (9.52)4 (3.03)
  16119 (11.45)0 (0)6 (11.54)8 (9.52)12 (9.09)
  19206 (19.83)0 (0)26 (50)13 (15.48)13 (9.85)
  24205 (19.73)0 (0)7 (13.46)18 (21.43)28 (21.21)
  29138 (13.28)0 (0)4 (7.69)10 (11.9)19 (14.39)
  3284 (8.08)84 (30.22)2 (3.85)9 (10.71)18 (13.64)
  3764 (6.16)63 (22.66)1 (1.92)1 (1.19)13 (9.85)
  4063 (6.06)63 (22.66)0 (0)8 (9.52)12 (9.09)
  4439 (3.75)39 (14.03)0 (0)4 (4.76)8 (6.06)
  4829 (2.79)29 (10.43)0 (0)4 (4.76)5 (3.79)
Stent length, mm, mean ± SD25.57 ± 9.3538.30 ± 5.2420.25 ± 5.2926.45 ± 10.1229.11 ± 9.21
Stent diameter, mm, n (%)n = 1,039n = 278n = 52n = 84n = 132
  2.5247 (23.77)74 (26.62)0 (0)22 (26.19)37 (28.03)
  2.75162 (15.59)50 (17.99)0 (0)13 (15.48)18 (13.64)
  3363 (34.94)104 (37.41)0 (0)26 (30.95)48 (36.36)
  3.5214 (20.6)47 (16.91)0 (0)19 (22.62)28 (21.21)
  438 (3.66)2 (0.72)37 (71.15)4 (4.76)0 (0)
  4.515 (1.44)1 (0.36)15 (28.85)0 (0)1 (0.76)
Stent diameter, mm, mean ± SD (n = 1,039)3.00 ± 0.442.92 ± 0.364.14 ± 0.232.99 ± 0.432.94 ± 0.38
% Diameter stenosis, pre-procedure, mean ± SD83.93 ± 12.8483.48 ± 12.3783.12 ± 17.3085.04 ± 12.6899.21 ± 3.74
% Diameter stenosis post-procedure, mean ± SD4.22 ± 11.504.91 ± 8.734.12 ± 6.904.64 ± 13.283.25 ± 10.69
Reference vessel diameter, mm, mean ± SD2.96 ± 0.472.92 ± 0.453.89 ± 0.702.93 ± 0.462.90 ± 0.53
Minimum lumen diameter, pre-procedure, mm, mean ± SD1 ± 1.691.12 ± 2.881.33 ± 1.001.08 ± 0.970.79 ± 1.91
Minimum lumen diameter post-procedure, mm, mean ± SD2.96 ± 1.352.76 ± 0.653.84 ± 0.493.09 ±2.752.88 ± 0.65

 

Table 4. Cumulative Outcomes After 24 Months Follow-Up
 
EventsIn-hospital (n = 771)1 month (n = 760)9 months (n = 733)12 months (n = 717)24 months (n = 691)
Values are n (%). aOne patient suffered from MI, TVR, TVR including TLR. bFour patients suffered from MI, TVR, TVR including TLR. cEight patients suffered from MI, TVR, TVR including TLR. dTen patients suffered from MI, TVR, TVR including TLR. eTwelve patients suffered from MI, TVR, TVR including TLR. f, gAmong 21 patients, fone patient had MI at 1 and 24 months, gone patient had MI at 9 and 24 months. MI: myocardial infarction; TVR: target vessel revascularization; TLR: target lesion revascularization; TVF: target vessel failure (composite of cardiac deaths, MI, and TVR including TLR); MACE: major adverse cardiovascular events (composite endpoint of cardiac death, MI, and TVR).
Death0 (0)1 (0.13)6 (0.81)8 (1.11)14 (2.02)
Cardiac death0 (0)1 (0.13)2 (0.27)2 (0.28)6 (0.87)
Non-cardiac death0 (0)0 (0)3 (0.40)4 (0.55)5 (0.72)
Undetermined death0 (0.00)0 (0.00)1 (0.13)2 (0.28)3 (0.43)
MI1 (0.13)a6 (0.78)b, f14 (1.90)c, g18 (2.51)d21 (3.03)e, f, g
TVR1 (0.13)a5 (0.65)b14 (1.90)c17 (2.37)d23 (3.32)e
TVR including TLR1 (0.13)a5 (0.65)b14 (1.90)c17 (2.37)d23 (3.32)e
TLR0 (0)3 (0.39)12 (1.63)15 (2.09)21 (3.03)
Stent thrombosis0 (0)0 (0)1 (0.13)2 (0.28)2 (0.28)
TVF1 (0.13)8 (1.05)23 (3.13)29 (4.04)39 (5.64)
MACE1 (0.13)8 (1.05)23 (3.13)29 (4.04)39 (5.64)

 

Table 5. Cumulative Outcomes up to 24 Months Follow-Up for Population Treated With Stent > 30 mm in Length
 
EventsIn-hospital (n = 253)1 month (n = 248)9 months (n = 239)12 months (n = 234)24 months (n = 228)
Values are presented in n (%). aOne patient suffered from MI, TVR and TVR including TLR. bFour patients suffered from MI, TVR and TVR including TLR. cFive patients suffered from MI, TVR and TVR including TLR. dSix patients suffered from MI, TVR and TVR including TLR. e, fAmong nine patients, eone patient had MI at 1 and 24 months, fone patient had MI at 9 and 24 months follow-up. MI: myocardial infarction; TVR: target vessel revascularization; TLR: target lesion revascularization; TVF: target vessel failure (composite of cardiac deaths, MI and TVR including TLR); MACE: major adverse cardiovascular events (composite endpoint of cardiac death, MI and TVR).
Death0 (0)0 (0)2 (0.84)3 (1.38)5 (2.19)
Cardiac death0 (0)0 (0)1 (0.42)1 (0.43)3 (1.32)
Non-cardiac death0 (0)0 (0)1 (0.42)2 (0.85)2 (0.88)
Undetermined death0 (0)0 (0)0 (0)0 (0)0 (0)
MI0 (0)1 (0.40)a, e6 (2.51)b, f7 (2.99)c9 (3.95)d, e, f
TVR0 (0)1 (0.40)a8 (3.35)b9 (3.85)c12 (5.26)d
TVR including TLR0 (0)1 (0.40)a8 (3.35)b9 (3.85)c12 (5.26)d
TLR0 (0)1 (0.40)8 (3.35)9 (3.85)12 (5.26)
Stent thrombosis0 (0)0 (0)1 (0.42)1 (0.43)1 (0.44)
TVF0 (0)1 (0.40)11 (4.60)12 (5.12)16 (7.01)
MACE0 (0)1 (0.40)11 (4.60)12 (5.12)16 (7.01)

 

Table 6. Cumulative Clinical Events up to 24 Months for Population Treated With 4.00- and 4.50-mm Diameter Stent
 
EventsIn-hospital (n = 49)1 month (n = 49)9 months (n = 48)12 months (n = 48)24 months (n = 48)
Values are presented in n (%). aOne patient suffered from MI, TVR and TVR including TLR. bOne patient suffered from MI, TVR and TVR including TLR. cTwo patients suffered from MI, TVR and TVR including TLR. dOne same patient had MI at 9 and 24 months follow-up. MI: myocardial infarction; TVR: target vessel revascularization; TLR: target lesion revascularization; TVF: target vessel failure (composite of cardiac deaths, MI and TVR including TLR); MACE: major adverse cardiovascular events (composite endpoint of cardiac death, MI and TVR).
Death0 (0)0 (0)1 (2.08)1 (2.08)4 (8.33)
Cardiac death0 (0)0 (0)0 (0)0 (0)1 (2.08)
Non-cardiac death0 (0)0 (0)0 (0)0 (0)1 (2.08)
Undetermined death0 (0)0 (0)1 (2.08)1 (2.08)2 (4.17)
MI0 (0)0 (0)2 (4.17)a, d2 (4.17)b3 (6.25)c, d
TVR0 (0)0 (0)1 (2.08)a1 (2.08)b2 (4.17)c
TVR including TLR0 (0)0 (0)1 (2.08)a1 (2.08)b2 (4.17)c
TLR0 (0)0 (0)1 (2.08)1 (2.08)2 (4.17)
Stent thrombosis0 (0)0 (0)0 (0)0 (0)0 (0)
TVF0 (0)0 (0)3 (6.25)3 (6.25)5 (10.41)
MACE0 (0)0 (0)3 (6.25)3 (6.25)5 (10.41)

 

Table 7. Cumulative Major Cardiac Clinical Events up to 24 Months in Patients With Bifurcation Lesions
 
EventsIn-hospital (n = 82)1-month (n = 81)9-months (n = 79)12-months (n = 78)24-months (n = 74)
Values are presented in n (%). aOne patient suffered from MI, TVR and TVR including TLR. bTwo patients suffered from MI, TVR and TVR including TLR. cFour patients suffered from MI, TVR and TVR including TLR. dFour patients suffered from MI, TVR and TVR including TLR. eOne same patient had MI at 1- and 24-month follow-up. MI: myocardial infarction; TVR: target vessel revascularization; TLR: target lesion revascularization; TVF: target vessel failure (composite of cardiac deaths, MI and TVR including TLR); MACE: major adverse cardiovascular events (composite endpoint of cardiac death, MI and TVR).
Death0 (0)0 (0)0 (0)1 (1.28)3 (4.05)
Cardiac death0 (0)0 (0)0 (0)0 (0)1 (1.35)
Non-cardiac death0 (0)0 (0)0 (0)0 (0)0 (0)
Undetermined death0 (0)0 (0)0 (0)1 (1.28)2 (2.70)
MI0 (0)1 (1.23)a, e3 (3.84)b6 (7.69)c7 (9.46)d, e
TVR0 (0)2 (2.47)a4 (5.06)b6 (7.69)c7 (9.46)d
TVR including TLR0 (0)2 (2.47)a4 (5.06)b6 (7.69)c7 (9.46)d
TLR0 (0)2 (2.47)4 (5.06)6 (7.69)7 (9.46)
Stent thrombosis0 (0)0 (0)1 (1.27)1 (1.28)1 (1.35)
TVF0 (0)2 (2.46)5 (6.32)9 (11.53)12 (16.21)
MACE0 (0)2 (2.46)5 (6.32)9 (11.53)12 (16.21)

 

Table 8. Cumulative Major Cardiac Events up to 24 Months Follow-Up for Population With CTO
 
EventsIn-hospital (n = 127)1 month (n = 126)9 months (n = 119)12 months (n = 117)24 months (n = 113)
Values are presented in n (%). aTwo patients suffered from MI, TVR and TVR including TLR. bThree patients suffered from MI, TVR and TVR including TLR. cThree patients suffered from MI, TVR and TVR including TLR. MI: myocardial infarction; TVR: target vessel revascularization; TLR: target lesion revascularization; TVF: target vessel failure (composite of cardiac deaths, MI and TVR including TLR); MACE: major adverse cardiovascular events (composite endpoint of cardiac death, MI and TVR).
Death0 (0)0 (0)2 (1.68)2 (1.71)2 (1.77)
  Cardiac death0 (0)0 (0)1 (0.84)1 (0.85)1 (0.88)
  Non-cardiac death0 (0)0 (0)1 (0.84)1 (0.85)1 (0.88)
  Undetermined death0 (0)0 (0)0 (0)0 (0)0 (0)
MI0 (0)1 (0.79)4 (3.36)a5 (4.27)b5 (4.42)c
TVR0 (0)0 (0)3 (2.52)a5 (4.27)b5 (4.42)c
TVR including TLR0 (0)0 (0)3 (2.52)a5 (4.27)b5 (4.42)c
TLR0 (0)0 (0)3 (2.52)5 (4.27)5 (4.42)
Stent thrombosis0 (0)0 (0)1 (0.84)1 (0.85)1 (0.88)
TVF0 (0)1 (0.79)6 (5.04)8 (6.83)8 (7.07)
MACE01 (0.79)6 (5.04)8 (6.83)8 (7.07)

 

Table 9. Clinical Outcomes Comparison of BioMime Stent With Other Drug-Coated/Bare Metal Stents
 
StentsNo. of patients (n)Clinical follow-upCardiac deathNon-cardiac deathMITVRSTTVFMACE
aMACE (composite endpoint of cardiac death, MI, and TVR). bMACE (composite of cardiac death, MI, and TLR). cARC defined - probable/definite. dMACE (death, MI, TVR). eMACE (composite of cardiac death, target vessel-related reinfarction, and ischemia-driven target-lesion revascularization). BMS: bare metal stent; EES: everolimus-eluting stent; MACE: major adverse cardiovascular events; MI: myocardial infarction; SES: sirolimus-eluting stent; ST: stent thrombosis; TVF: target vessel failure, TVR: target vessel revascularization; ZES: zotarolimus-eluting stent.
BioMime SES6912 years6 (0.87)5.5 (0.72)21 (3.03)23 (3.32)2 (0.28)39 (5.64)39 (5.64)a
XIENCE EES [40]3652 years3 (0.8)-11(3.0)7 (1.9)6 (1.6)-22 (6.0)b
Resolute ZES [41]1392 years1 (0.7)3 (2.2)8 (5.8)2 (1.4)0 (0.0)11 (7.9)14 (10.1)
MiStent SES [42]1232 years2 (1.7)1 (0.8)3 (2.5)2 (1.7)1 (0.0)c6 (5.0)8 (6.7)d
Endeavor Sprint ZES [42]612 years1 (1.7)0 (0.0)3 (5.0)5 (8.3)1 (1.7)c7 (11.7)8 (13.3)d
Biolimus [43]5751 year16 (2.9)--11 (2.0)5 (0.9)-24 (4.3)e
Orsiro SES [26]1,2452 years21 (1.6)-39 (3.2)57 (4.7)11 (0.9)87 (7.1)107 (8.6)
Gazelle BMS [43]5821 year20 (3.5)--37 (6.5)12 (2.1)-49 (8.7)e