Early Outcome after Bioresorbable Vascular Scaffold Implantation in Patients with Acute Coronary Syndrome

Abstract

The term acute coronary syndrome (ACS) refers to any group of clinical symptoms compatible with acute myocardial ischemia and includes unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). These high-risk manifestations of coronary atherosclerosis are important causes of the use of emergency medical care and hospitalization. High-risk patients with UA/NSTEMI are often treated with an early invasive strategy involving cardiac catheterization and prompt revascularization of viable myocardium at risk. Transradial approach has important impact in reduction of bleeding and vascular complications. We evaluated the feasibility and the acute performance of the everolimus-eluting bioresorbable vascular scaffolds (BVS) for the treatment of patients presenting with ACS. Methods and results: The present investigation was a prospective, single-centre study, reporting data after BVS implantation in patients presenting with ACS. Clinical outcomes were reported at the 30-day, 6-month, 1 year and 2 years follow-up. Quantitative coronary angiography and optical coherence tomography (OCT) data were also evaluated. The intent-to-treat population comprises a total of 21 patients. The procedural success was 100.0%. In 14 patients (66.7%) BVS were implanted on left anterior descending artery (LAD), 4 patients (19.0%) on right coronary artery (RCA), 3 patients (14.3%) on circumflex artery (Cx). Pre-procedure TIMI-flow was 0 in 8 patients (38.1%). After the BVS implantation a TIMI flow 3 was achieved in all 21 patients and the post-procedure percentage diameter stenosis was 16.7 +/- 8.9%. No patients had angiographically visible residual thrombus at the end of the procedure. OCT analysis was performed in 13 patients (61.9%) showed that the post-procedure mean lumen area was 7.88 +/- 1.84 mm2, minimum lumen area 5.52 +/- 1.59 mm2. At the 30-day, 6-month, 1 year (15 patients) and 2 years follow-up (8 patients) target-lesion failure rate was 0%. Non-target vessel revascularization and target vessel myocardial infarction (MI) were not reported. No cases of cardiac death or scaffold thrombosis were observed. Conclusion: BVS implantation in patients presenting with ACS appeared feasible, with high rate of final TIMI-flow III and good scaffold apposition. Larger studies are currently needed to confirm these preliminary data. Keywords: Bioresorbable vascular scaffold, acute coronary syndrome, Optical coherence tomography.