In a randomized comparison of the Supraflex Cruz and SYNERGY drug-eluting stents, Supraflex Cruz proved to be noninferior with respect to the composite of all-cause death, stroke, myocardial infarction (MI) and revascularization at one year in patients with three-vessel disease undergoing PCI, according to MULTIVESSEL TALENT findings presented at TCT 2025.

The trial randomized 1,550 participants with de novo three-vessel disease from 54 sites in Spain, Germany, Ireland, France, Poland, Italy, the Netherlands and the UK to receive either the Supraflex Cruz stent (n=775) or the SYNERGY stent (n=775).

A primary endpoint composite event occurred in 15.3% of patients in the Supraflex Cruz group (n=117) compared with 14.6% (n=11) in the SYNERGY group. The observed rate of periprocedural MI (PPMI) increased the incidence of PPMI and consequently the rate of the composite endpoint, according to Patrick W. Serruys, MD, FACC, who presented the findings. He also noted that a pre-specified analysis of the anatomical SYNTAX Score showed that in the highest strata of anatomical SYNTAX score (≥33, n=161), the Supraflex Cruz is numerically superior to the SYNERGY in terms of the primary endpoint.

The trial had some limitations, including that screening was based on an eyeball detection of stenotic lesions. "Many of the so-called three-vessel disease, when investigated by physiology, were in fact one or two-vessel disease, and only 35% were true three-vessel disease from a functional point of view," said Serruys. Additionally, he added that "the historical evolution of the criteria for periprocedural MI, as well as the diversity of assays used for troponin, is a confounding factor in the interpretation of trials, resulting in a variety of composite endpoints and margins of noninferiority."

Clinical Topics: Acute Coronary Syndromes, Invasive Cardiovascular Angiography and Intervention, Interventions and ACS, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Transcatheter Cardiovascular Therapeutics, TCT25, Angiography, Acute Coronary Syndrome