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Impact of postdilatation on performance of bioresorbable vascular scaffolds in patients with acute coronary syndrome compared with everolimus-eluting stents: A propensity score-matched analysis from a multicenter “real-world” registry
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Abstract
Background: Safety and efficacy of bioresorbable vascular scaffolds (BRS) and the role of postdilatation on outcome in acute coronary syndrome (ACS) patients compared with those of everolimus-eluting stents (EES) remain unknown. The aim of the study is to compare the safety and efficacy of BRS with EES in ACS and to investigate the role of BRS postdilatation.
Methods: Consecutive ACS patients undergoing BRS implantation in 8 centers were compared with those with EES before and after propensity score matching. Major adverse cardiac event (MACE), myocardial infarction, and target lesion revascularization (TLR) were the primary endpoint. Sensitivity analysis was performed according to postdilatation after BRS implantation. We enrolled 303 BRS and 748 EES patients; 215 from each group were compared after matching, and 117 (55.2%) BRS patients were treated with postdilatation.
Results: After a median follow-up of 24.0 months, MACE rates were higher in BRS patients than in EES patients (9.3% vs. 4.7%, p < 0.001), mainly driven by TLR (6.1% vs. 1.9%, p < 0.001). Stent thrombosis increased in the BRS group (2.8% vs. 0.9%, p = 0.01). However, after sensitivity analysis, MACE rates in BRS patients with postdilatation were significantly lower than in those without, comparable to EES patients (6.0% vs. 12.6% vs. 4.7%, p < 0.001). The same trend was observed for TLR (3.4% vs. 8.4% vs. 1.9%, p < 0.001). Stent thrombosis rates were higher in both the BRS groups than in EES patients (2.6% vs. 3.2% vs. 0.9%, p = 0.045).
Conclusions: Postdilatation appears effective when using BRS in ACS patients. MACE rates are comparable to those of EES, although scaffold thrombosis is not negligible. Randomized prospective studies are required for further investigation.
Abstract
Background: Safety and efficacy of bioresorbable vascular scaffolds (BRS) and the role of postdilatation on outcome in acute coronary syndrome (ACS) patients compared with those of everolimus-eluting stents (EES) remain unknown. The aim of the study is to compare the safety and efficacy of BRS with EES in ACS and to investigate the role of BRS postdilatation.
Methods: Consecutive ACS patients undergoing BRS implantation in 8 centers were compared with those with EES before and after propensity score matching. Major adverse cardiac event (MACE), myocardial infarction, and target lesion revascularization (TLR) were the primary endpoint. Sensitivity analysis was performed according to postdilatation after BRS implantation. We enrolled 303 BRS and 748 EES patients; 215 from each group were compared after matching, and 117 (55.2%) BRS patients were treated with postdilatation.
Results: After a median follow-up of 24.0 months, MACE rates were higher in BRS patients than in EES patients (9.3% vs. 4.7%, p < 0.001), mainly driven by TLR (6.1% vs. 1.9%, p < 0.001). Stent thrombosis increased in the BRS group (2.8% vs. 0.9%, p = 0.01). However, after sensitivity analysis, MACE rates in BRS patients with postdilatation were significantly lower than in those without, comparable to EES patients (6.0% vs. 12.6% vs. 4.7%, p < 0.001). The same trend was observed for TLR (3.4% vs. 8.4% vs. 1.9%, p < 0.001). Stent thrombosis rates were higher in both the BRS groups than in EES patients (2.6% vs. 3.2% vs. 0.9%, p = 0.045).
Conclusions: Postdilatation appears effective when using BRS in ACS patients. MACE rates are comparable to those of EES, although scaffold thrombosis is not negligible. Randomized prospective studies are required for further investigation.
Keywords
angina pectoris, myocardial infarction, coronary restenosis, thrombosis, cardiac death
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About this articleTitle
Impact of postdilatation on performance of bioresorbable vascular scaffolds in patients with acute coronary syndrome compared with everolimus-eluting stents: A propensity score-matched analysis from a multicenter “real-world” registry
Journal
Issue
Pages
374-383
Published online
2016-08-01
Page views
2437
Article views/downloads
1958
DOI
Pubmed
Bibliographic record
Cardiol J 2016;23(4):374-383.
Keywords
angina pectoris
myocardial infarction
coronary restenosis
thrombosis
cardiac death
Authors
Yoichi Imori
Fabrizio D'Ascenzo
Tommaso Gori
Thomas Münzel
Fabrizio Ugo
Gianluca Campo
Enrico Cerrato
L. Christian Napp
Mario Iannaccone
Jelena R. Ghadri
Elycia Kazemian
Ronald K. Binder
Milosz Jaguszewski
Adam Csordas
Piera Capasso
Simone Biscaglia
Fedrico Conrotto
Ferdinando Varbella
Roberto Garbo
Fiorenzo Gaita
Paul Erne
Thomas F. Lüscher
Claudio Moretti
Antonio H. Frangieh
Christian Templin
