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Minerva Cardiology and Angiology 2021 Aug 02

DOI: 10.23736/S2724-5683.21.05703-3


language: English

Four-year outcomes of a single-center experience with coronary everolimus-eluting bioresorbable scaffolds

Francesco CONTORNI , Matteo CAMELI, Alessandro IADANZA, Arcangelo CARRERA, Giuseppe GUERRIERI, Riccardo BARBATI, Giuseppe SINICROPI, Elodi BACCI, Bernardo BACCANI, Massimo FINESCHI

Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy


BACKGROUND: Bioresorbable scaffolds (BRS) have been introduced to overcome the limitations of drug-eluting stents and the ABSORB (Everolimus-eluting BRS, Abbott Vascular, Santa Clara, CA) was the most extensively tested. Nevertheless, major RCTs reported higher rates of target lesion failures and BRS thrombosis at 3 years follow-up, bringing to the withdrawing of the device from the market. It has been suggested that a better lesions selection and an optimized implantation technique could mitigate the displayed adverse results.
METHODS: Consecutive patients undergoing BRS implantation were included in this observational, single center study. Clinical follow-up was conducted up to 4 years. Endpoint of interest was the target lesion failure (TLF), a composite outcome including cardiac death, target vessel myocardial infarction and target lesion revascularization.
RESULTS: A total of 62 patients with a mean age of 55±8.5 years were analysed of which 70.9% presented with an acute coronary syndrome and 59.6% with myocardial infarction. A total of 100 lesions were treated and 51.6% were complex (B2/C). Predilatation was performed in all the case, post-dilatation in 74.1%. All the target vessel reference diameter (RVD) were > 2.5 mm (average RVD 3.2 ± 0.24 mm). At 4 years, the rate for TLF was 6.9%. Subgroups analysis did not show significative differences among groups although consistently higher event rates were found for RVD < 2.5 mm (12.6 vs 6.4% p 0.5), BRS overlapping (11.8 vs 5% p 0.2) and Ticagrelor instead of Clopidogrel on top of Cardioaspirin (9.1 vs 3% p 0.2).
CONCLUSIONS: This small-sized real-world registry displays lower rates of clinical events during long-term follow-up in respect to previous studies. The avoidance of implantation in small vessels, inclusion of acute myocardial infarction and extensive performance of BRS post-dilatation could explain the observed better results. Long term outcomes of the ongoing ABSORB IV trial are needed to confirm this data.

KEY WORDS: Bioresorbable vascular scaffold; Scaffold thrombosis; ABSORB trial

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