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, USA) was the most extensively tested. Nevertheless, major RCTs reported higher rates of target lesion failures and BRS thrombosis at 3 years follow-up, bring-ing to the withdrawing of the device from the market. It has been suggested that a better lesions selection and an opti-mized 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 revascularizationRESULTS: A total of 62 patients with a mean age of 55 +/- 8.5 years were analyzed 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%. Subgroup's 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.

Contorni, F., Cameli, M., Iadanza, A., Carrera, A., Guerrieri, G., Barbati, R., et al. (2023). Four-year outcomes of a single-center experience with coronary everolimus-eluting bioresorbable scaffolds. MINERVA CARDIOLOGY AND ANGIOLOGY, 71(1), 70-76 [10.23736/S2724-5683.21.05703-3].

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

Contorni, Francesco;Cameli, Matteo;Iadanza, Alessandro;Carrera, Arcangelo;Guerrieri, Giuseppe;Barbati, Riccardo;Bacci, Elodi;Baccani, Bernardo;Fineschi, Massimo
2023-01-01

Abstract

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, USA) was the most extensively tested. Nevertheless, major RCTs reported higher rates of target lesion failures and BRS thrombosis at 3 years follow-up, bring-ing to the withdrawing of the device from the market. It has been suggested that a better lesions selection and an opti-mized 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 revascularizationRESULTS: A total of 62 patients with a mean age of 55 +/- 8.5 years were analyzed 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%. Subgroup's 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.
2023
Contorni, F., Cameli, M., Iadanza, A., Carrera, A., Guerrieri, G., Barbati, R., et al. (2023). Four-year outcomes of a single-center experience with coronary everolimus-eluting bioresorbable scaffolds. MINERVA CARDIOLOGY AND ANGIOLOGY, 71(1), 70-76 [10.23736/S2724-5683.21.05703-3].
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11365/1235714