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Structural and Functional Evaluation of Coronary Arteries Treated With ABSORB Bioresorbable Vascular Scaffold at 5-Year Follow-Up. Am J Cardiol 2022; 182:1-7. [PMID: 36075756 DOI: 10.1016/j.amjcard.2022.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/06/2022] [Accepted: 07/11/2022] [Indexed: 11/23/2022]
Abstract
Although complete bioresorbable vascular scaffold (BVS) resorption has been demonstrated at 5-year follow-up, whether corresponding vasomotor function restoration occurs remains unknown. The objective was to simultaneously assess the structural healing response along with vasomotor responses at 5-year follow-up of BVS implantation. We studied consecutive patients treated with ABSORB-BVS at 5-year follow-up (n = 31), who were recruited from a multicenter registry and were contacted to undergo a research protocol-driven repeat coronary angiogram involving intracoronary optical coherence tomography (OCT) and invasive coronary endothelial function testing. Epicardial endothelium-dependent vasomotion was defined as any vasodilatation after intracoronary acetylcholine (ACh), whereas endothelium-independent vasomotion was defined as any vasodilatation after intracoronary nitroglycerine (NTG), using quantitative coronary angiography. The mean implantation time point was 60.5 ± 4.6 months. OCT imaging demonstrated complete scaffold resorption in all patients. New coronary lesions (stenosis >50%) were found in 5 patients (16.1%), 3 of them underwent ad hoc percutaneous revascularization (9.7%). Intracoronary ACh (27 patients) and NTG testing (30 patients) was performed. Quantitative coronary angiography analysis demonstrated vasoconstriction after ACh administration and lack of response to NTG in BVS segments (mean lumen diameter = 2.00 ± 0.61 mm at baseline vs 1.74 ± 0.70 mm post-ACh, p <0.001; 2.05 ± 0.54 mm at baseline vs 2.03 ± 0.50 mm post-NTG, p = 0.69). OCT lumen analysis demonstrated similar vasoconstrictive responses to ACh (mean lumen area = 5.31 ± 2.26 mm2 at baseline vs 5.12 ± 2.55 mm2 post-ACh, p = 0.007) but had a vasodilatory response to NTG (5.96 ± 2.35 mm2 at baseline vs 6.17 ± 2.55 mm2 post-NTG, p<0.001). In conclusion, complete ABSORB-BVS resorption was demonstrated at 5-year follow-up. However, this healing response was associated with endothelium-dependent vasomotor dysfunction within the BVS segment.
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De Maria GL, Terentes‐Printzios D, Banning AP. Thrombus‐containing Lesions. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Altisent OAJ, Goncalves-Ramírez LR, Fernández L, Viladés D, Gutiérrez E, Mitomo S, Latib A, Córdoba-Soriano JG, Adeliño R, Amat-Santos I, Muñoz JF, Elízaga J, Bezzera H, Pereira GTR, de Prado AP, Carrillo X, Fernández-Nofrerias E, Vilalta V, Rodríguez-Leor O, Llibre C, Fadeuilhe E, Trujillo A, Mauri J, de la Torre Hernández JM, Bayes-Genís A, Puri R. Long-Term Intracoronary Structural and Vasomotor Assessment of the ABSORB Bioresorbable Vascular Scaffold. Am J Cardiol 2022; 168:55-63. [PMID: 35058053 DOI: 10.1016/j.amjcard.2021.12.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/13/2021] [Accepted: 12/20/2021] [Indexed: 12/16/2022]
Abstract
We systematically categorized the longer-term (≥3 years) structural and functional characteristics of the ABSORB bioresorbable vascular scaffold (BVS) using optical coherence tomography imaging and coronary vasomotor reactivity testing and further compared the functional characteristics of BVS stented versus remote coronary segments. A total of 92 patients (mean age 56.4 ± 9.7 years, 22.8% women) who underwent percutaneous coronary intervention (76% with acute coronary syndrome) using the ABSORB BVS (112 lesions) were included. Optical coherence tomography analysis (38,790 visible struts) comprised in-segment quantitative lumen/plaque and semiquantitative plaque composition analysis of the neointimal pattern. Epicardial endothelium-dependent and-independent vasomotion was defined as any vasodilatation at low/intermediate intracoronary dose of acetylcholine (ACh) and nitroglycerine, assessed using quantitative coronary angiography. At a median time of 3.2 years follow-up, 79.8% of BVS segments still demonstrated visible struts with a predominant neointimal fibrotic healing pattern in 84% of BVS segments, with 99.5% of struts demonstrating coverage with apposition. Compared with remote segments, BVS segments demonstrated less endothelium-dependent vasodilatation at low (p = 0.06) and intermediate ACh doses (p = 0.04). Hypertension, longer time interval from index percutaneous coronary intervention, and the degree of in-BVS segment neointimal volume (p <0.03 for all) were each independently associated with abnormal BVS endothelium-dependent vasomotor function. Endothelium-independent function was more likely preserved in non-BVS (remote) segments compared with BVS segments (p = 0.06). In conclusion, at 3+ years post-ABSORB BVS insertion, the rate of complete scaffold resorption was low and residual strut presence was high, with a dominant fibrous healing response contributing toward neointimal hyperplasia and endothelium-dependent and-independent vasomotor dysfunction.
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Marrone A, Pavasini R, Scollo E, Gibiino F, Pompei G, Caglioni S, Biscaglia S, Campo G, Tebaldi M. Acetylcholine Use in Modern Cardiac Catheterization Laboratories: A Systematic Review. J Clin Med 2022; 11:jcm11041129. [PMID: 35207403 PMCID: PMC8880288 DOI: 10.3390/jcm11041129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/09/2022] [Accepted: 02/18/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The use of acetylcholine for the diagnosis of vasospastic angina is recommended by international guidelines. However, its intracoronary use is still off-label due to the absence of safety studies. We aimed to perform a systematic review of the literature to identify adverse events related to the intracoronary administration of acetylcholine for vasoreactivity testing to fill this gap. METHODS AND RESULTS We conducted a systematic review of observational studies and randomized controlled trials dealing with the intracoronary administration of acetylcholine. Articles were searched in MEDLINE (PubMed) using the MeSH strategy. Three independent reviewers determined whether the studies met the inclusion and exclusion criteria. A total of 434 articles were selected. Data concerning clinical characteristics, study population, acetylcholine dosage, and adverse effects were retrieved from the articles. Overall, 71,566 patients were included, of which only 382 (0.5%) developed one adverse event, and there were no fatal events reported (0%). CONCLUSIONS Intracoronary administration of acetylcholine in the setting of coronary spasm provocation testing is safe and plays a central role in the evaluation of coronary vasomotion disorders, making it worthy of becoming a part of clinical practice in all cardiac catheterization laboratories.
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Función endotelial y microvascular distal a stents farmacoactivos sin polímero y captadores de células endoteliales. Estudio aleatorizado FUNCOMBO. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2021.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Moscarella E, Campo G, Leoncini M, Geraci S, Nicolini E, Cortese B, Loi B, Guiducci V, Saccà S, Varricchio A, Vicinelli P, De Candia G, Silvestro A, Calabrò P, Brugaletta S, Latib A, Tespili M, Ielasi A. Three-year results of ST-segment elevation myocardial infarction patients treated with a prespecified bioresorbable vascular scaffold implantation strategy. J Cardiovasc Med (Hagerstown) 2021; 23:278-280. [DOI: 10.2459/jcm.0000000000001286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Gomez-Lara J, Oyarzabal L, Ortega-Paz L, Brugaletta S, Romaguera R, Salvatella N, Roura G, Rivero F, Fuentes L, Alfonso F, Otaegui I, Vandeloo B, Vaquerizo B, Sabate M, Comin-Colet J, Gomez-Hospital JA. Coronary Endothelium-Dependent Vasomotor Function After Drug-Eluting Stent and Bioresorbable Scaffold Implantation. J Am Heart Assoc 2021; 10:e022123. [PMID: 34729992 PMCID: PMC8751934 DOI: 10.1161/jaha.121.022123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Early generation drug-eluting stents (DESs) showed a high grade of coronary endothelial dysfunction that was attributed to lack of stent reendothelialization. Endothelium-dependent vasomotor response of current DESs and bioresorbable scaffolds (BRSs) remains unknown. This study sought to assess the device-related endothelial function of current devices and to correlate neointima healing with endothelial function. Methods and Results A total of 206 patients from 4 randomized trials treated with the durable-polymer everolimus-eluting Xience (n=44), bioresorbable-polymer sirolimus-eluting Orsiro (n=35), polymer-free biolimus-eluting Biofreedom (n=24), bioactive endothelial-progenitor cell-capturing sirolimus-eluting Combo DES (n=25), polymer-based everolimus-eluting Absorb (n=44), and Mg-based sirolimus-eluting Magmaris BRS (n=34) underwent endothelium-dependent vasomotor tests and optical coherence tomography imaging, as per protocol, at follow-up. Crude vasomotor responses of distal segments to low-dose acetylcholine (10-6 mol/L) were different between groups: bioresorbablepolymer DEShad the worst (-8.4%±12.6%) and durable-polymer DES had the most physiologic (-0.4%±11.8%; P=0.014). High-dose acetylcholine (10-4 mol/L) showed similar responses between groups (ranging from -10.8%±11.6% to -18.1%±15.4%; P=0.229). Device healing was different between devices. Uncovered struts ranged from 6.3%±7.1% (bioresorbable-polymer DES) to 2.5%±4.5% (bioactive DES; P=0.056). In multivariate models, endothelium-dependent vasomotor response was associated with age, bioresorbable-polymer DES, and angiographic lumen loss, but not with strut coverage nor plaque type. Endothelial dysfunction (defined as ≥4% vasoconstriction) was observed in 46.6% of patients with low-dose and 68.9% with high-dose acetylcholine, without differences between groups. Conclusions At follow-up, endothelial dysfunction was frequently observed in distal segments treated with current stents without remarkable differences between devices. Although neointima healing was different between devices, poor healing was not associated with endothelial dysfunction.
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Affiliation(s)
- Josep Gomez-Lara
- University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge (IDIBELL) University of Barcelona, L' Hospitalet de Llobregat Spain
| | - Loreto Oyarzabal
- University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge (IDIBELL) University of Barcelona, L' Hospitalet de Llobregat Spain
| | - Luis Ortega-Paz
- Clinic Hospital of Barcelona August Pi i Sunyer Biomedical Research Institute (IDIBAPS) Barcelona Spain
| | - Salvatore Brugaletta
- Clinic Hospital of Barcelona August Pi i Sunyer Biomedical Research Institute (IDIBAPS) Barcelona Spain
| | - Rafael Romaguera
- University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge (IDIBELL) University of Barcelona, L' Hospitalet de Llobregat Spain
| | - Neus Salvatella
- Heart Disease Research Group Mar Hospital, Biomedical Research Institute of Mar Hospital (IMIM) Barcelona Spain
| | - Gerard Roura
- University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge (IDIBELL) University of Barcelona, L' Hospitalet de Llobregat Spain
| | - Fernando Rivero
- University Hospital of La Princesa Health Resaerch Institute of La Princesa; CIBER-CV Madrid Spain
| | - Lara Fuentes
- University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge (IDIBELL) University of Barcelona, L' Hospitalet de Llobregat Spain
| | - Fernando Alfonso
- University Hospital of La Princesa Health Resaerch Institute of La Princesa; CIBER-CV Madrid Spain
| | - Imanol Otaegui
- Interventional Cardiology Department University Hospital of Vall Hebron Barcelona Spain
| | - Bert Vandeloo
- University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge (IDIBELL) University of Barcelona, L' Hospitalet de Llobregat Spain.,Department of Cardiology Heart and Vascular Disease Center, Universty Hospital of Brussels Brussels Belgium
| | - Beatriz Vaquerizo
- Heart Disease Research Group Mar Hospital, Biomedical Research Institute of Mar Hospital (IMIM) Barcelona Spain
| | - Manel Sabate
- Clinic Hospital of Barcelona August Pi i Sunyer Biomedical Research Institute (IDIBAPS) Barcelona Spain
| | - Josep Comin-Colet
- University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge (IDIBELL) University of Barcelona, L' Hospitalet de Llobregat Spain
| | - Joan-Antoni Gomez-Hospital
- University Hospital of Bellvitge, Biomedical Research Institute of Bellvitge (IDIBELL) University of Barcelona, L' Hospitalet de Llobregat Spain
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Bennett J, Ielasi A, Torzewski J, de Hemptinne Q, Cerrato E, Lanocha M, Galli S, Sabaté M. The resorbable magnesium scaffold Magmaris in acute coronary syndrome: An appraisal of evidence and user group guidance. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 39:106-113. [PMID: 34629285 DOI: 10.1016/j.carrev.2021.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/30/2021] [Accepted: 09/27/2021] [Indexed: 11/15/2022]
Abstract
Bioresorbable scaffolds provide transient vessel support without the long-term limitations of permanent metallic drug-eluting stents. The sirolimus-eluting resorbable magnesium scaffold Magmaris is the only CE-marked metallic bioresorbable scaffold and provides short-term lumen support before being completely bioresorbed. To date, clinical trial results have demonstrated low adverse event rates in patients with simple coronary lesions. Seven European centers with large experience in Magmaris implantation, combined efforts in an informal collaboration to evaluate and appraise clinical data currently available regarding the performance of Magmaris in patients presenting with acute coronary syndromes, and to supply user-advice on patient selection and optimal implantation practice.
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Affiliation(s)
- Johan Bennett
- Department of Cardiovascular Medicine, University Hospitals Leuven and Department of Cardiovascular Sciences, Katholieke Universiteit Leuven, Leuven, Belgium.
| | - Alfonso Ielasi
- Cardiology Division ASST Bergamo Est, Seriate and lnterventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Jan Torzewski
- Cardiovascular Center Oberallgau-Kempten, Kempten, Germany
| | - Quentin de Hemptinne
- Department of Cardiology, CHU Saint Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Enrico Cerrato
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital (Orbassano) and Rivoli Infermi Hospital (Rivoli), Turin, Italy
| | | | - Stefano Galli
- Monzino Cardiology Centre Research and Teaching Hospital, University of Milan, Italy
| | - Manel Sabaté
- Department of Cardiology, Hospital Clinic de Barcelona, Barcelona, Spain
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Gómez-Lara J, Oyarzabal L, Brugaletta S, Salvatella N, Romaguera R, Roura G, Fuentes L, Pérez Fuentes P, Ortega-Paz L, Ferreiro JL, Teruel L, Gracida M, Vaquerizo B, Sabaté M, Comín-Colet J, Gómez-Hospital JA. Coronary endothelial and microvascular function distal to polymer-free and endothelial cell-capturing drug-eluting stents. The randomized FUNCOMBO trial. ACTA ACUST UNITED AC 2021; 74:1013-1022. [PMID: 33640311 DOI: 10.1016/j.rec.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION AND OBJECTIVES The vasomotor function of new-generation drug-eluting stents designed to enhance stent healing and reendothelialization is unknown. This study aimed to compare the endothelial function of the infarct-related artery (IRA) treated with bioactive circulating endothelial progenitor cell-capturing sirolimus-eluting stents (COMBO) vs polymer-free biolimus-eluting stents (BioFreedom) in ST-segment elevation myocardial infarction patients at 6 months. Secondary objectives were to compare the microcirculatory function of the IRA and stent healing at 6 months. METHODS Sixty patients were randomized to bioactive sirolimus-eluting stent vs polymer-free biolimus-eluting stents implantation. At 6 months, patients underwent coronary angiography with vasomotor, microcirculatory and optical coherence tomography examinations. Endothelial dysfunction of the distal coronary segment was defined as ≥ 4% vasoconstriction to intracoronary acetylcholine infusion. RESULTS Endothelial dysfunction was similarly observed between groups (64.0% vs 62.5%, respectively; P=.913). Mean lumen diameter decreased by 16.0 ±20.2% vs 16.1 ±21.6% during acetylcholine infusion (P=.983). Microcirculatory function was similar in the 2 groups: coronary flow reserve was 3.23 ±1.77 vs 3.23±1.62 (P=.992) and the index of microcirculatory resistance was 24.8±16.8 vs 21.3±12.0 (P=.440). Optical coherence tomography findings were similar: uncovered struts (2.3% vs 3.2%; P=.466), malapposed struts (0.1% vs 0.3%; P=.519) and major evaginations (7.1% vs 5.6%; P=.708) were observed in few cases. CONCLUSIONS Endothelial dysfunction of the IRA was frequent and was similarly observed with new-generation drug-eluting stents designed to enhance stent reendothelialization at 6 months. Endothelial dysfunction was observed despite almost preserved microcirculatory function and complete stent coverage. Larger and clinically powered studies are needed to assess the role of residual endothelial dysfunction in ST-segment elevation myocardial infarction patients. Registered in ClinicalTrials.gov: NCT04202172.
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Affiliation(s)
- Josep Gómez-Lara
- Departament de Cardiologia Intervencionista, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Loreto Oyarzabal
- Departament de Cardiologia Intervencionista, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Salvatore Brugaletta
- Departament de Cardiologia Intervencionista, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Neus Salvatella
- Departament de Cardiologia Intervencionista, Hospital del Mar, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Rafael Romaguera
- Departament de Cardiologia Intervencionista, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Gerard Roura
- Departament de Cardiologia Intervencionista, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Lara Fuentes
- Departament de Cardiologia Intervencionista, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Pedro Pérez Fuentes
- Departament de Cardiologia Intervencionista, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Luis Ortega-Paz
- Departament de Cardiologia Intervencionista, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - José L Ferreiro
- Departament de Cardiologia Intervencionista, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Luis Teruel
- Departament de Cardiologia Intervencionista, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Montserrat Gracida
- Departament de Cardiologia Intervencionista, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Beatriz Vaquerizo
- Departament de Cardiologia Intervencionista, Hospital del Mar, Barcelona, Spain; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Manel Sabaté
- Departament de Cardiologia Intervencionista, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Josep Comín-Colet
- Departament de Cardiologia Intervencionista, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Joan-Antoni Gómez-Hospital
- Departament de Cardiologia Intervencionista, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
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Ng AKY, Ng PY, Siu CW, Jim MH. Factors associated with long-term major adverse cardiac events of coronary bioresorbable vascular scaffold. Cardiovasc Interv Ther 2021; 36:462-469. [PMID: 33387354 DOI: 10.1007/s12928-020-00723-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 10/14/2020] [Indexed: 11/25/2022]
Abstract
The long-term clinical outcomes after implantation of bioresorbable vascular scaffolds (BVS) in a real-world cohort were not well described. To identify factors associated with major adverse cardiovascular events (MACE) on long-term follow-up after implantation of BVS in patients undergoing elective percutaneous coronary intervention (PCI). This was an observational study based on a hospital registry of percutaneous coronary intervention. Participants were consecutive patients who underwent PCI and implanted with at least one everolimus-eluting BVS (Absorb®) in a single center between 2014 and 2017. Among the 170 cases analyzed (mean age 60.4 ± 10.7), a total of 203 Absorb BVS were implanted. MACE developed in 33 (19.4%) patients over a median follow-up period of 61 months, including 9 (5.3%) deaths, 13 (7.6%) non-fatal myocardial infarction and 19 (11.2%) ischemia driven target vessel revascularization. Definite or probable stent thrombosis developed in 4 (2.4%) patients. In crude analysis, history of smoking and initial presentation of non-ST elevation-acute coronary syndrome (NSTE-ACS) were predictors of long-term MACE. In adjusted analysis, presentation with NSTE-ACS was an independent predictor of long-term MACE [adjusted odds ratio (OR) 4.52; 95% confidence interval (95% CI) 1.50 to 13.6, P = 0.007]. Among patients receiving implantation of ABSORB BVS, presentation with NSTE-ACS was an independent predictor of MACE after a median follow-up period of 61 months. Future research is needed to confirm these findings and to determine the long-term safety of BVS in patients with NSTE-ACS.
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Affiliation(s)
- Andrew Kei-Yan Ng
- Cardiac Medical Unit, Grantham Hospital, 125 Wong Chuk Hang Road, Hong Kong Sar, China
| | - Pauline Yeung Ng
- Department of Adult Intensive Care, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China
- Division of Respiratory and Critical Care Medicine, Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Chung-Wah Siu
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong SAR, Hong Kong SAR, China
| | - Man-Hong Jim
- Cardiac Medical Unit, Grantham Hospital, 125 Wong Chuk Hang Road, Hong Kong Sar, China.
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Gomez-Lara J, Ortega-Paz L, Brugaletta S, Cuesta J, Romaní S, Serra A, Salinas P, García del Blanco B, Goicolea J, Hernandez-Antolín R, Antuña P, Romaguera R, Regueiro A, Rivero F, Cequier À, Alfonso F, Gómez-Hospital JA, Sabaté M. Bioresorbable scaffolds versus permanent sirolimus-eluting stents in patients with ST-segment elevation myocardial infarction: vascular healing outcomes from the MAGSTEMI trial. EUROINTERVENTION 2020; 16:e913-e921. [DOI: 10.4244/eij-d-20-00198] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Gomez-Lara J, Salvatella N, Romaguera R, Brugaletta S, Ñato M, Roura G, Ferreiro JL, Teruel L, Gracida M, Sabate M, Vaquerizo B, Cequier À, Gomez-Hospital JA. Coronary vasomotor function and myocardial flow with bioresorbable vascular scaffolds or everolimus-eluting metallic stents: a randomised trial. EUROINTERVENTION 2020; 16:e155-e163. [PMID: 31217148 DOI: 10.4244/eij-d-18-01203] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to compare the hyperaemic flow and vasomotor response to endothelium-dependent stimuli between bioresorbable vascular scaffolds (BVS) and metallic everolimus-eluting stents (EES) at 13 months. METHODS AND RESULTS Seventy non-diabetic patients aiming to achieve complete revascularisation were randomised 1:1 to BVS or EES implantation. At 13 months, invasive coronary angiography was performed using intracoronary pressure and Doppler ultrasound measurements at rest and maximal hyperaemia. A vasomotor test to endothelium-dependent (acetylcholine) and independent (nitroglycerine) stimuli and optical coherence tomography (OCT) were also performed. Fifty-nine patients (30 BVS and 29 EES) underwent 13-month examination. Doppler ultrasound average peak velocity (49.0±17.5 vs 49.3±18.3 cm/sec; p=0.95), coronary blood flow (97.4±53.5 vs 88.3±46.7 ml/min; p=0.51), coronary flow reserve (2.6±0.9 vs 2.7±0.8; p=0.84) and fractional flow reserve (0.92±0.06 vs 0.94±0.04; p=0.17) were similar between the groups. The vasomotor test showed vasoconstriction response to acetylcholine in 75.6% proximal and 72.2% distal peri-scaffold segments without differences between study devices. BVS had larger in-scaffold vasoconstriction than EES (60.0% vs 27.6%; p=0.01) despite similar neointima response as assessed by OCT. CONCLUSIONS BVS and EES had similar microcirculatory response to hyperaemia and predominant vasoconstrictive response in the peri-scaffold segments to endothelium-dependent stimuli. However, BVS exhibited larger vasoconstriction to endothelium-dependent stimuli in the scaffold segment.
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Affiliation(s)
- Josep Gomez-Lara
- Grup de Recerca en Malalties del Cor, Hospital Universitari de Bellvitge; Institut d´Investigacio Biomedica de Bellvitge (IDIBELL), Universitat de Barcelona, L´Hospitalet de Llobregat, Spain
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Fractional Flow Reserve following Percutaneous Coronary Intervention. J Interv Cardiol 2020; 2020:7467943. [PMID: 32565755 PMCID: PMC7293753 DOI: 10.1155/2020/7467943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/05/2020] [Accepted: 05/11/2020] [Indexed: 11/18/2022] Open
Abstract
Fractional flow reserve (FFR) is routinely used to determine lesion severity prior to percutaneous coronary intervention (PCI). However, there is an increasing recognition that FFR may also be useful following PCI to identify mechanisms leading to restenosis and the need for repeat revascularization. Post-PCI FFR is associated with the presence and severity of stent under-expansion and may help identify peri-stent-related complications. FFR pullback may also unmask other functionally significant lesions within the target vessel that were not appreciable on angiography. Recent studies have confirmed the prognostic utility of performing routine post-PCI FFR and suggest possible interventional targets that would improve stent durability. In this review, we detail the theoretical basis underlying post-PCI FFR, provide practical tips to facilitate measurement, and discuss the growing evidence supporting its use.
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Ortega-Paz L, Brugaletta S, Gómez-Lara J, Sabaté M. Response by Ortega-Paz et al to Letter Regarding Article, "Magnesium-Based Resorbable Scaffold Versus Permanent Metallic Sirolimus-Eluting Stent in Patients With ST-Segment Elevation Myocardial Infarction: The MAGSTEMI Randomized Clinical Trial". Circulation 2020; 141:e748-e749. [PMID: 32282250 DOI: 10.1161/circulationaha.120.045964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Luis Ortega-Paz
- Interventional Cardiology Department, Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain (L.O.-P., S.B., M.S.)
| | - Salvatore Brugaletta
- Interventional Cardiology Department, Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain (L.O.-P., S.B., M.S.)
| | | | - Manel Sabaté
- Interventional Cardiology Department, Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain (L.O.-P., S.B., M.S.)
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Comparison of the everolimus-eluting bioresorbable vascular scaffold versus the everolimus-eluting metallic stent in real-world patients with ST-segment elevation myocardial infarction. Adv Cardiol 2020; 16:49-57. [PMID: 32368236 PMCID: PMC7189143 DOI: 10.5114/aic.2020.93912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/03/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Despite the withdrawal of the ABSORB bioresorbable vascular scaffold (BVS) from clinical use, continuous observation of BVS-treated patients is necessary. In the vast majority of clinical trials, patients with ST-segment elevation myocardial infarction (STEMI) were excluded from the analysis. AIM To compare the early and long-term outcomes of the BVS with the everolimus-eluting metallic stent (EES) in patients with STEMI. MATERIAL AND METHODS Consecutive patients treated with BVS or EES in our center were screened. For analysis, only patients with STEMI were enrolled. The primary endpoint was a comparison of the target lesion failure at 12 and 24 months. The secondary endpoints encompass occurrence of the patient-oriented cardiovascular endpoint (PoCE), stent thrombosis (ST), device, and procedural success. RESULTS Between 2012 and 2016, 2,137 patients were hospitalized for STEMI. Of these, 123 patients received the BVS (163 scaffolds; 151 lesions), whereas in 141 patients the EES (203 stents; 176 lesions) was implanted. The median follow-up was 931 ±514 days. The primary endpoint at 12 months occurred in 9.7% in the BVS group and in 8.5% in the EES group (hazard ratio (HR) = 2.61; 95% confidence interval (CI): 0.90-7.56; p = 0.076). At 24 months the incidence of the primary endpoint was 15.2% in the BVS group and 14.9% in the EES group (HR = 2.46; 95% CI: 0.85-7.07; p = 0.095). The rates of PoCE, ST, device, and procedural success were also comparable in both groups. CONCLUSIONS STEMI patients treated with the BVS showed statistically similar rates of primary and secondary endpoints compared with the EES.
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Abstract
Fully bioresorbable scaffolds (BRS) were designed to overcome the limitations of metallic drug-eluting stents, which permanently cage the vessel wall, thereby preventing normal coronary vasomotion, preclude bypass grafting and can provoke long-term foreign-body responses. Although multiple scaffolds have been or are in development, the Absorb Bioresorbable Vascular Scaffold (BVS; Abbott Vascular) was the first FDA-approved device and was widely expected to fulfil the dream of interventional cardiologists of a transient scaffold that would disappear 'when the job was done' and would not hamper further treatment options. Although early, small studies and even large, randomized trials showed beneficial outcomes up to 1 year of follow-up, longer-term results have been disappointing, with increased rates of device thrombosis and target-lesion revascularization. The Absorb BVS device was withdrawn from the market because of low demand. In this Review, we summarize the preclinical and clinical data available for BRS to understand how the vascular biological reactions to these devices differ from biological reactions to metallic drug-eluting stents and how these responses translate into clinical outcomes. We also discuss next-generation BRS and outline modifications that are needed to improve the long-term outcomes with these devices so that they eventually become a viable option for patients with symptomatic obstructive coronary artery disease.
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Moriyama N, Shishido K, Tanaka Y, Laine M, Saito S. Neoatherosclerosis - Long-Term Assessment of Bioresorbable Vascular Scaffold. Circ Rep 2019; 1:543-549. [PMID: 33693100 PMCID: PMC7897685 DOI: 10.1253/circrep.cr-19-0100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Although metallic stents improved the safety and efficacy of percutaneous coronary intervention (PCI), even the latest generation of drug-eluting stents (DES) is still limited by several factors. The limitations of DES are mainly related to the permanent metallic caging in vessel, chronic inflammatory response to the polymer and adverse effects of antiproliferative drug on endothelial tissue, leading to impaired physiological vasomotor response and late stent-related adverse events such as stent thrombosis and neoatherosclerosis. Bioresorbable vascular scaffold (Absorb BVS; Abbott Vascular) was designed to overcome these drawbacks of DES by disappearing from the vessel wall. Absorb BVS, however, was withdrawn from the world market because of increased incidence of scaffold thrombosis compared with DES. Importantly, only very limited long-term post-BVS implantation data are available, especially with regard to neoatherosclerosis, which can lead to very late adverse events even after resorption of the scaffold. Therefore, the goal of this review was to highlight the mid to long term clinical outcomes published to date, and to describe the features of the intimal healing process and neoatherosclerosis in the 5 years following Absorb BVS implantation, mainly based on our previous study. This may provide important information on the pathophysiology of the scaffolded vessel for clinicians, and promote identification of future bioresorbable materials for PCI that will minimize the stimulus for neoatherosclerosis.
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Affiliation(s)
- Noriaki Moriyama
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital Kamakura Japan.,Department of Cardiology, Heart and Lung Center, Helsinki University and Helsinki University Central Hospital Helsinki Finland
| | - Koki Shishido
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital Kamakura Japan
| | - Yutaka Tanaka
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital Kamakura Japan
| | - Mika Laine
- Department of Cardiology, Heart and Lung Center, Helsinki University and Helsinki University Central Hospital Helsinki Finland
| | - Shigeru Saito
- Department of Cardiology and Catheterization Laboratories, Shonan Kamakura General Hospital Kamakura Japan
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18
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Sabaté M, Alfonso F, Cequier A, Romaní S, Bordes P, Serra A, Iñiguez A, Salinas P, García Del Blanco B, Goicolea J, Hernández-Antolín R, Cuesta J, Gómez-Hospital JA, Ortega-Paz L, Gomez-Lara J, Brugaletta S. Magnesium-Based Resorbable Scaffold Versus Permanent Metallic Sirolimus-Eluting Stent in Patients With ST-Segment Elevation Myocardial Infarction: The MAGSTEMI Randomized Clinical Trial. Circulation 2019; 140:1904-1916. [PMID: 31553204 DOI: 10.1161/circulationaha.119.043467] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The use of poly-l-lactide acid-based bioresorbable scaffolds is limited in daily clinical practice because of safety concerns and lack of physiological benefit. Magnesium-based bioresorbable scaffold (MgBRS) presents a short resorption period (<1 year) and have the potential of being thromboresistant and exhibiting early restoration of vasomotor function. To date, however, no randomized clinical trial has investigated the performance of MgBRS. Therefore, this study aimed to compare the in-stent/scaffold vasomotion between MgBRS and permanent metallic sirolimus-eluting stent (SES) at 12-month follow-up in ST-segment-elevation myocardial infarction patients. METHODS This investigator-driven, multicenter, randomized, single-blind, controlled trial randomized ST-segment-elevation myocardial infarction patients 1:1 to SES or MgBRS at 11 academic centers. The primary end point was the rate of increase (≥3%) after nitroglycerin in mean lumen diameter of the in-stent/scaffold segment at 12 months with superiority of MgBRS over SES in the as-treated population. The main secondary end points included angiographic parameters of restenosis, device-oriented composite end point, their individual components, and device thrombosis rate. Besides, endothelial-dependent vasomotor response to acetylcholine (ie, endothelial function) was also assessed in a subgroup of patients (n=69). RESULTS Between June 2017 and June 2018, 150 ST-segment-elevation myocardial infarction patients were randomized (MgBRS, n=74; SES, n=76). At 1 year, the primary end point was significantly higher in the MgBRS arm (56.5% versus 33.8%; P=0.010). Conversely, late lumen loss was significantly lower in the SES group (in-segment: 0.39±0.49mm versus 0.02±0.27mm, P<0.001; in-device: 0.61±0.55mm versus 0.06±0.21mm; P<0.001). The device-oriented composite end point was higher in the MgBRS arm driven by an increase in ischemia-driven target lesion revascularization rate (12[16.2%] versus 4[5.2%], P=0.030). Definite thrombosis rate was similar between groups (1[1.4%] in the MgBRS arm versus 2[2.6%] in the SES group; P=1.0). Endothelial function assessment at device segment evidenced a more pronounced vasoconstrictive response to maximal dose of acetylcholine in the MgBRS arm (-8.3±3.5% versus -2.4±1.3% in the SES group, P=0.003). CONCLUSIONS When compared to SES, MgBRS demonstrated a higher capacity of vasomotor response to pharmacological agents (either endothelium-independent or endothelium-dependent) at 1 year. However, MgBRS was associated with a lower angiographic efficacy, a higher rate of target lesion revascularization, without thrombotic safety concerns. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT03234348.
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Affiliation(s)
- Manel Sabaté
- Interventional Cardiology Department, Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain (M.S., S.B.)
| | - Fernando Alfonso
- Hospital Universitario de La Princesa, Madrid, Spain (F.A., J.C.)
| | - Angel Cequier
- Hospital Universitario de Bellvitge, IDIBELL, Barcelona, Spain (A.C., J.A.G.H.)
| | | | | | - Antonio Serra
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (A.S.)
| | | | | | | | | | | | - Javier Cuesta
- Hospital Universitario de La Princesa, Madrid, Spain (F.A., J.C.)
| | | | - Luis Ortega-Paz
- Barcicore, Cardiac Imaging Corelab, Barcelona, Spain (L.O.P., J.G.L.)
| | - Josep Gomez-Lara
- Barcicore, Cardiac Imaging Corelab, Barcelona, Spain (L.O.P., J.G.L.)
| | - Salvatore Brugaletta
- Interventional Cardiology Department, Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain (M.S., S.B.)
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Gheorghe L, Millán X, Jimenez-Kockar M, Gomez-Lara J, Arzamendi D, Danduch L, Agudelo V, Serra A. Bioresorbable vascular scaffolds in coronary chronic total occlusions: clinical, vasomotor and optical coherence tomography findings at three-year follow-up (ABSORB-CTO study). EUROINTERVENTION 2019; 15:99-107. [DOI: 10.4244/eij-d-18-00567] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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20
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Stuijfzand WJ, Schumacher SP, Driessen RS, Lammertsma AA, Bakker AL, Rijnierse MT, van Rossum AC, van de Ven PM, Nap A, Appelman Y, van Royen N, van Leeuwen MA, Lemkes JS, Raijmakers PG, Knaapen P. Myocardial Blood Flow and Coronary Flow Reserve During 3 Years Following Bioresorbable Vascular Scaffold Versus Metallic Drug-Eluting Stent Implantation. JACC Cardiovasc Interv 2019; 12:967-979. [DOI: 10.1016/j.jcin.2019.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/04/2019] [Accepted: 03/05/2019] [Indexed: 10/26/2022]
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Tijssen RYG, van der Schaaf RJ, Kraak RP, Vink MA, Hofma SH, Arkenbout EK, Weevers APJD, Kerkmeijer LSM, Onuma Y, Serruys PW, Beijk MAM, Koch KT, Baan J, Vis MM, Piek JJ, Tijssen JGP, Henriques JPS, de Winter RJ, Wykrzykowska JJ. Clinical outcomes at 2 years of the Absorb bioresorbable vascular scaffold versus the Xience drug-eluting metallic stent in patients presenting with acute coronary syndrome versus stable coronary disease-AIDA trial substudy. Catheter Cardiovasc Interv 2019; 95:89-96. [PMID: 30968559 DOI: 10.1002/ccd.28193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/15/2019] [Accepted: 03/01/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Patients with acute coronary syndrome (ACS) might represent a specific subgroup, in which bioresorbable scaffold implantation in percutaneous coronary intervention (PCI), might lead to better outcomes when compared to conventional treatment with metallic drug eluting stents. In this prespecified subgroup analysis of the Amsterdam Investigator-Initiated Absorb Strategy All-Comers (AIDA) trial, we evaluated the clinical outcomes of Absorb bioresorbable vascular scaffold (BVS) versus Xience everolimus eluting stent (EES) treated patients presenting either with or without ACS. METHODS AND RESULTS We classified AIDA patients on the basis of clinical presentation of ACS or of no-ACS. The rate of the 2-year primary endpoint of target vessel failure (TVF) was similar after treatment with Absorb BVS or Xience EES in ACS patients (10.2% versus 9.0% respectively; P = 0.49) and in no-ACS patients (11.7% versus 10.7%, respectively; P = 0.67) Definite or probable device thrombosis occurred more frequently with Absorb BVS compared to Xience EES in ACS patients (4.3% versus 1.7%, respectively, P = 0.03) as well as in no-ACS patients (2.4% versus 0.2%, respectively; P = 0.002). There were no statistically significant interactions between clinical presentation and randomized device modality for TVF (P = 0.80) and for the endpoint of definite or probable device thrombosis (P = 0.17). CONCLUSION In the AIDA trial, the 2-year outcomes of PCI with Absorb BVS versus Xience EES were consistent in ACS and no-ACS patients: similar rates for TVF and consistently higher rates of definite or probable stent thrombosis under Absorb BVS versus Xience EES. There were no statistically significant interactions between clinical presentation and randomized device modality.
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Affiliation(s)
- Ruben Y G Tijssen
- Amsterdam UMC, University of Amsterdam, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Rene J van der Schaaf
- The Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Robin P Kraak
- Amsterdam UMC, University of Amsterdam, Heart Center, Academic Medical Center, Amsterdam, The Netherlands.,The Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Maarten A Vink
- The Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Sjoerd H Hofma
- The Department of Cardiology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - E Karin Arkenbout
- The Department of Cardiology, Tergooi Hospital, Blaricum, The Netherlands
| | - Auke P J D Weevers
- The Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Laura S M Kerkmeijer
- Amsterdam UMC, University of Amsterdam, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | | | | | - Marcel A M Beijk
- Amsterdam UMC, University of Amsterdam, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Karel T Koch
- Amsterdam UMC, University of Amsterdam, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Jan Baan
- Amsterdam UMC, University of Amsterdam, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - M Marije Vis
- Amsterdam UMC, University of Amsterdam, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Jan J Piek
- Amsterdam UMC, University of Amsterdam, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Jan G P Tijssen
- Amsterdam UMC, University of Amsterdam, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Jose P S Henriques
- Amsterdam UMC, University of Amsterdam, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Robbert J de Winter
- Amsterdam UMC, University of Amsterdam, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Joanna J Wykrzykowska
- Amsterdam UMC, University of Amsterdam, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
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22
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Mahtta D, Elgendy IY. Everolimus-eluting bioresorbable vascular scaffolds: learning from the past to improve the future. Minerva Cardioangiol 2019; 67:288-305. [PMID: 30895764 DOI: 10.23736/s0026-4725.19.04900-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Bioresorbable vascular scaffolds (BVS) were developed to overcome the long-term limitations of metallic drug-eluting stents (DES). Shortcomings of DES include their permanent metallic cage which prevents normal coronary vasomotion, vascular remodeling, precludes future bypass grafting, and creates a nidus for very late stent thrombosis. With its transient scaffold which provides early mechanical support and subsequently resorbs thereby restoring physiologic properties and architecture of the vasculature, BVS offers a promising development within the field of interventional cardiology. Even though various BVS have been or are currently under development, the ABSORB BVS from Abbott Vascular was the first FDA approved device. In this review, we shed light on shortcomings of the current generation DES and theoretical advantages of BVS. In addition, we will discuss in detail clinical data from observational studies, meta-analyses, registries, and randomized controlled trials as it pertains to the efficacy and safety outcomes with everolimus-eluting BVS as compared to the current generation everolimus-eluting metallic stents (EES). We will summarize reasons behind the disappointing results from clinical trials and the failure of first generation BVS leading to its withdrawal from the market. Lastly, we will briefly review ongoing developments with the newer-generation BVS and future pre-clinical and clinical studies that are underway to evaluate the efficacy and safety of second-generation BVS.
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Affiliation(s)
- Dhruv Mahtta
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA -
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Katagiri Y, Onuma Y, Asano T, Iñiguez A, Jensen LO, Cequier À, Hofma SH, Christiansen EH, Suttorp M, Brugaletta S, Räber L, Sabaté M, Windecker S, Serruys PW. Three-year follow-up of the randomised comparison between an everolimus-eluting bioresorbable scaffold and a durable polymer everolimus-eluting metallic stent in patients with ST-segment elevation myocardial infarction (TROFI II trial). EUROINTERVENTION 2018; 14:e1224-e1226. [PMID: 30398967 DOI: 10.4244/eij-d-18-00839] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Yuki Katagiri
- Amsterdam University Medical Center, Amsterdam, the Netherlands
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24
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Tesfamariam B. Bioresorbable Scaffold-Based Controlled Drug Delivery for Restenosis. J Cardiovasc Transl Res 2018; 12:193-203. [DOI: 10.1007/s12265-018-9841-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 10/17/2018] [Indexed: 12/22/2022]
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26
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Understanding the Impact of Stent and Scaffold Material and Strut Design on Coronary Artery Thrombosis from the Basic and Clinical Points of View. Bioengineering (Basel) 2018; 5:bioengineering5030071. [PMID: 30181463 PMCID: PMC6164756 DOI: 10.3390/bioengineering5030071] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 08/23/2018] [Accepted: 08/30/2018] [Indexed: 01/09/2023] Open
Abstract
The technology of percutaneous coronary intervention (PCI) is constantly being refined in order to overcome the shortcomings of present day technologies. Even though current generation metallic drug-eluting stents (DES) perform very well in the short-term, concerns still exist about their long-term efficacy. Late clinical complications including late stent thrombosis (ST), restenosis, and neoatherosclerosis still exist and many of these events may be attributed to either the metallic platform and/or the drug and polymer left behind in the arterial wall. To overcome this limitation, the concept of totally bioresorbable vascular scaffolds (BRS) was invented with the idea that by eliminating long-term exposure of the vessel wall to the metal backbone, drug, and polymer, late outcomes would improve. The Absorb-bioabsorbable vascular scaffold (Absorb-BVS) represented the most advanced attempt to make such a device, with thicker struts, greater vessel surface area coverage and less radial force versus contemporary DES. Unfortunately, almost one year after its initial approval by the U.S. Food and Drug Administration, this scaffold was withdrawn from the market due to declining devise utilization driven by the concerns about scaffold thrombosis (ScT) seen in both early and late time points. Additionally, the specific causes of ScT have not yet been fully elucidated. In this review, we discuss the platform, vascular response, and clinical data of past and current metallic coronary stents with the Absorb-BVS and newer generation BRS, concentrating on their material/design and the mechanisms of thrombotic complications from the pre-clinical, pathologic, and clinical viewpoints.
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Long-Term Vasomotion After Absorb: Fact or Fiction? JACC Cardiovasc Interv 2018; 11:1572-1575. [PMID: 30139464 DOI: 10.1016/j.jcin.2018.05.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 05/16/2018] [Indexed: 11/20/2022]
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