Clinical outcomes of ultra-thin versus thin strut contemporary drug-eluting stent platforms in patients treated with small-diameter stents: a retrospective cohort study

Contemporary drug-eluting stents (DES) have evolved toward thinner metallic struts, but whether ultra-thin strut DES provide additional clinical benefit over other contemporary thin-strut DES—particularly in small coronary vessels, where strut thickness is expected to matter most—remains uncertain. We compared clinical outcomes between ultra-thin and other contemporary thin-strut DES platforms in patients treated with small-diameter stents. In this retrospective single-center cohort study, patients who underwent percutaneous coronary intervention (PCI) between 2014 and 2021 with contemporary DES and a minimal stent diameter ≤ 3.0 mm were analyzed. Ultra-thin strut DES (strut thickness < 70 μm; Orsiro and BioMime) were compared with other contemporary cobalt-chromium or platinum-chromium thin-strut DES. The primary endpoint was target vessel failure (TVF), a composite of cardiac death, target-vessel myocardial infarction, or target vessel revascularization. Inverse probability of treatment weighting (IPTW) was applied to adjust for baseline differences, and outcomes were assessed with Cox proportional hazards models in the crude and weighted populations. Among 1,337 patients, 406 received ultra-thin strut DES and 931 received thin-strut DES; the median follow-up was 730 days. In the crude population, TVF occurred in 6.2% of the ultra-thin strut group and 7.8% of the thin-strut group (hazard ratio [HR], 0.81; 95% confidence interval [CI], 0.51–1.27). After IPTW, the weighted incidence of TVF was 5.4% versus 8.2% (HR, 0.71; 95% CI, 0.44–1.13), without a significant difference. Major adverse cardiovascular events (MACE) and individual clinical outcomes were also comparable after weighting (MACE: HR, 0.82; 95% CI, 0.59–1.15). No significant interaction was observed across prespecified subgroups, including age, diabetes, myocardial infarction presentation, renal function, multivessel disease, minimal stent diameter, and complex PCI. Within the ultra-thin strut group, outcomes were similar between Orsiro and BioMime. Among patients treated with contemporary DES ≤ 3.0 mm in diameter, ultra-thin strut DES were not associated with a significantly lower risk of TVF than other contemporary thin-strut DES. When the comparator is already a contemporary thin-strut platform, further strut thinning may provide limited incremental clinical benefit in small-diameter PCI.