Abstract
ObjectivesTo investigate one-year outcomes after implantation of a bioresorbable vascular scaffold (BVS) in patients presenting with acute coronary syndrome (ACS) compared to stable angina patients. BackgroundRobust data on the outcome of BVS in the setting of ACS is still scarce. MethodsTwo investigator initiated, single-center, single-arm BVS registries have been pooled for the purpose of this study, namely the BVS Expand and BVS STEMI registries. ResultsFrom September 2012–October 2014, 351 patients with a total of 428 lesions were enrolled. 255 (72.6%) were ACS patients and 99 (27.4%) presented with stable angina/silent ischemia. Mean number of scaffold/patient was 1.55±0.91 in ACS group versus 1.91±1.11 in non-ACS group (P=0.11). Pre- and post-dilatation were performed less frequent in ACS patients, 75.7% and 41.3% versus 89.0% and 62.0% respectively (P=0.05 and P=0.001). Interestingly, post-procedural acute lumen gain and percentage diameter stenosis were superior in ACS patients, 1.62±0.65mm (versus 1.22±0.49mm, P<0.001) and 15.51±8.47% (versus 18.46±9.54%, P=0.04). Major adverse cardiac events (MACE) rate at 12months was 5.5% in the ACS group (versus 5.3% in stable group, P=0.90). One-year definite scaffold thrombosis rate was comparable: 2.0% for ACS population versus 2.1% for stable population (P=0.94), however, early scaffold thromboses occurred only in ACS patients. ConclusionsOne-year clinical outcomes in ACS patients treated with BVS were similar to non-ACS patients. Acute angiographic outcomes were better in ACS than in non-ACS, yet the early thrombotic events require attention and further research.
Highlights
Drug-eluting stents (DES) are the first choice devices in percutaneous coronary interventions (PCI)
Patients presenting with non-stent thrombosis (ST) elevation myocardial infarction (NSTEMI), stable or unstable angina (UA), or silent ischemia caused by a de novo stenotic lesion in a native previously untreated coronary artery with intention to treat with a bioresorbable vascular scaffold (BVS) were included in BVS Expand registry
Thirteen patients were excluded based on protocol related exclusion criteria of the BVS Expand registry and the BVS ST-elevation myocardial infarction (STEMI) registry and 79 patients declined to participate in one of the two follow-up registries
Summary
Drug-eluting stents (DES) are the first choice devices in percutaneous coronary interventions (PCI). Shortcomings related to the use of DES still are present such as delayed arterial healing, late stent thrombosis (ST), neo-atherosclerosis and hypersensitivity reactions to the polymer [1,2]. ⁎ Corresponding author at: Thoraxcenter, Room Ba585, Erasmus Medical Center, sGravendijkwal 230, 3015 CE Rotterdam, the Netherlands. To overcome these limitations, coronary devices made of fully bioresorbable material were developed to provide mechanical support and drug-delivery within the first year, followed by complete resorption. The BVS provides transient vessel support and gradually elutes the anti-proliferative drug everolimus. After degradation of the polymer (after approximately two to three years) no foreign material remains and need for late reintervention triggered by foreign material should be reduced [3]
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