SPC365

Bioabsorbable vascular scaffolds in clinical practice: not as bad as one might expect

Session: Sessão de Posters 29 - Intervenção coronária percutânea
Speaker: Sofia Esteves

Congress: CPC 2024
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 25. Interventional Cardiology
Subtheme: 25.2 Coronary Intervention
Session Type: Cartazes
FP Number: ---
Authors: Sofia Esteves; Ana Beatriz Garcia; Miguel Azaredo Raposo; Marta Vilela; Miguel Nobre Menezes; Cláudia Moreira Jorge; João Silva Marques; Pedro Pinto Cardoso; Fausto J. Pinto
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: Bioabsorbable vascular scaffolds (BVS) provide mechanical support for the first years after implantation and are completely resorbed thereafter. BVS prevent acute recoil and restenosis in the acute setting and may offer the advantage of decreasing very late stent thrombosis and restoring vascular function. However, randomized trials have challenged previous beliefs. In the ABSORB IV trial the 1-year target lesion failure (TLF) was 7,8% and thrombosis occurred in 1%.&nbsp;</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Aim</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: To evaluate the rate of thrombosis and TLF of BVS in a single center (SC) prospective observational study.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: Patients (pts) submitted to percutaneous coronary intervention (PCI) with BVS between 2012-2017 were included. Clinical characteristics and procedure-related data were collected at baseline and co-primary endpoints were prospectively gathered at one and 3 years and at the longest available follow-up (FUP). First co-primary endpoint was defined as a composite of target vessel myocardial infarction or cardiac mortality and second co-primary endpoint as device thrombosis.&nbsp;&nbsp;</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: One hundred and fourteen pts (71% male; mean age 52&plusmn;12 years) were submitted to PCI with BVS during the 5-year period, with a mean FUP of 94&plusmn;11 months. Cardiovascular (CDV) risk factors included hypercholesterolemia (79,8%), hypertension (74,6%), smoking habits (56,1%) and diabetes (34,2%).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Clinical reasons to perform PCI included stable angina in 28,9%, unstable angina in 5,3%, NSTEMI in 32,5% and STEMI in 33,3% of pts. BVS was implanted in LAD in 51,8% of pts, in RCA in 23,7%, 13,2% in circumflex and 5,3% in LM artery. Almost all BVS used were ABSORB, with a medium diameter and length of 3,39&plusmn;2,54mm and 19,99&plusmn;4,87mm, respectively. Regarding technique of BVS implantation,&nbsp;predilatation was done in a majority of pts (93%), but postdilatation was only done in 47,4% of pts. Intracoronary imaging use was limited to 28,1% and identified malapposition in 2,6% of cases and edge dissection in 7%.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">At FUP, new CDV events that lead to coronary angiography and PCI occurred in 16,7% of pts. Most (10,5%) were related to lesions in different coronary segments (non-TLF). TLF events were due to restenosis in 5,3% and BVS thrombosis occurred in 3,5%.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">First co-primary endpoints occurred in 10%, 1% and 4,4% at 1 and 3-year FUP, respectively. Smaller stent diameters (p=0,037) and diabetes (p=0,032) were significantly associated with TLF.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">A total of 4 BVS thrombosis were observed (3,5%), 1% at 1-year FUP and 2,2% at 3-years. Female gender (p=0,039) and obesity (p=0,044) were correlated with the second co-primary endpoint.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">&nbsp;</span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: BVS use fell since a higher rate of TLF and thrombosis was described. When compared with ABSORB IV, a significant lower rate of TLS was verified in our population. As BVS could limit APT in the long term and, technically, could offer advantages in complex lesions, more studies are warranted with new BVS generations.</span></span></span></p>