Sirolimus-eluting iron bioresorbable scaffold versus cobalt-chromium everolimus-eluting stents in patients with coronary artery disease: Rationale and design of the IRONMAN-II trial.

Am Heart J

Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Cardiology, Fuwai Yunan hospital, Chinese Academy of Medical Sciences, Kunming, China. Electronic address:

Published: September 2024

Background: The previous first-in-human study established the preliminary safety and effectiveness of the novel thin-strut iron bioresorbable scaffold (IBS). The current study aims to directly compare the imaging and physiological efficacy, and clinical outcomes of IBS with contemporary metallic drug-eluting stents (DES).

Methods: A total of 518 patients were randomly allocated to treatment with IBS (257 patients) or metallic DES (261 patients) from 36 centers in China. The study is powered to test noninferiority of the IBS compared with the metallic everolimus-eluting stent in terms of the primary endpoint of in-segment late lumen loss at 2 years, and major secondary endpoints including 2-year quantitative flow ratio and cross-sectional mean flow area measured by optical coherence tomography (OCT) (limited to the OCT subgroup, 25 patients in each group).

Conclusion: This will be the first powered randomized trial investigating the safety and efficacy of the novel thin-strut IBS compared to a contemporary metallic DES. The findings will provide valuable evidence for future research of this kind and the application of metallic bioresorbable scaffolds.

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http://dx.doi.org/10.1016/j.ahj.2024.05.019DOI Listing

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  • Both types of implants were successfully used, showing similar levels of arterial narrowing within the first six months, but the IBS scaffold exhibited gradual corrosion over time.
  • Overall, the findings indicate that the IBS is comparable to EES in terms of support and tissue response within 6 months, while demonstrating a manageable corrosion profile over a year.
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Article Synopsis
  • Percutaneous coronary intervention is a key treatment for coronary artery disease, especially for heart attacks, but traditional metallic stents can cause complications that bioresorbable stents aim to mitigate.
  • Bioresorbable polymeric stents face challenges like low mechanical strength, leading to thrombosis and inflammation, which has prompted interest in using bioresorbable metals like iron, zinc, and magnesium instead.
  • Early studies show promise for zinc and magnesium stents in terms of safety and absorption rates, but more extensive human clinical trials are necessary to confirm their effectiveness and address current limitations.
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