Biolimus-eluting vs. other limus-eluting stents in NSTE-ACS: A pooled analysis of GLASSY and TWILIGHT

Alessandro Spirito, Marco Valgimigli, Davide Cao, Usman Baber, Shamir R. Mehta, C. Michael Gibson, Gabriel P. Steg, Samin K. Sharma, Ridhima Goel, Kurt Huber, Vijay Kunadian, Javier Escaned, Anna Franzone, Han Yaling, Timothy Collier, Upendra Kaul, Ran Kornowski, Mitchell Krucoff, David Moliterno, Samantha SartoriRuth Owen, Zhongjie Zhang, George D. Dangas, Adnan Kastrati, Dominick J. Angiolillo, David J. Cohen, Pascal Vranckx, Stephan Windecker, Stuart Pocock, Roxana Mehran

Research output: Contribution to journalArticlepeer-review

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Background: Biodegradable polymer biolimus-eluting stents (BP-BES) may be associated with better outcomes in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI) compared to other current-generation limus-eluting stents (LES). Aims: To compare BP-BES with other current-generation LES in ACS patients undergoing PCI. Methods: We pooled individual data of Non-ST-segment elevation (NSTE)-ACS patients from two large randomized controlled trials (GLASSY and TWILIGHT). The BP-BES groups consisted mostly of GLASSY patients, while the control group (other current-generation LES) included exclusively TWILIGHT patients. The primary outcome was major adverse cardiovascular events (MACE), including cardiovascular death, myocardial infarction, or stent thrombosis; the key secondary outcome was target-vessel failure (TVF). To account for trial design differences, outcomes were assessed at 3 months (short-term) and between 3 and 12 months (long-term) after PCI and subsequently pooled to estimate the 12-month hazards. Results: Of 7107 and 6053 NSTE-ACS patients included in the short- and long-term analysis, 32.7% and 36.5% received a BP-BES, respectively. Risk of MACE associated with BP-BES versus other LES was similar at short-term (1.1% vs 1.3%, adjusted HR 0.86, 95%CI 0.53–1.38), lower at long-term (1.7% vs 3.1%, adjusted HR 0.49, 95%CI 0.34–0.72), and lower in the entire 12-month period (pooled adjusted HR 0.61, 95%CI 0.45–0.82). The cumulative 12-month risk of TVF was reduced with BP-BES (adjusted HR 0.52, 95%CI 0.38–0.70). Conclusion: BP-BES was associated with lower 12-month risks of MACE and TVF compared to other current generation LES among NSTE-ACS patients treated with abbreviated or standard ticagrelor-based DAPT. These non-randomized findings are hypothesis-generating. Condensed abstract: Differences in clinical outcomes may exist between biodegradable polymer biolimus-eluting stents (BP-BES) and other current-generation limus-eluting stent (LES) in patients with acute coronary syndrome (ACS). We pooled individual data of about 7000 Non-ST-segment elevation ACS patients undergoing PCI and treated with ticagrelor with or without aspirin from two large randomized controlled trials (GLASSY and TWILIGHT). BP-BES patients derived very largely from GLASSY and other LES patients from TWILIGHT. In this population, BP-BES compared to other current generation LES, were associated with a lower 12-month risk of major adverse cardiovascular events and target-vessel failure.

Original languageEnglish
Pages (from-to)24-32
Number of pages9
JournalInternational Journal of Cardiology
StatePublished - 15 Jul 2023


  • Biodegradable polymer
  • Biolimus eluting stent
  • Outcomes
  • Percutaneous coronary intervention
  • Ticagrelor


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