POSTER 2 7:17 – 7:24 Mid-Term Outcomes of the ABSORB® Bioresorbable Scaffold in STEMI patients: initial experience Presenter: Fabien Picard  Authors: Fabien Picard, Quentin de Hemptinne, Hung Q Ly, Reda Ibrahim, Pierre de Guise, Anita W Asgar, Jean-François Dorval, Marc E Jolicoeur, Serge Doucet, Jean Grégoire, Philippe L.- L’Allier, Jean-François Tanguay, Montreal Heart Institute

MID-term outcomes of the ABSORB® bioresorbable vascular Scaffold in STEMI patients : initial experience – the MIDAS-STEMI study Fabien Picard, Quentin de Hemptinne Hung Q Ly, Reda Ibrahim, Pierre de Guise, Anita W Asgar, Jean-François Dorval, Marc E Jolicoeur, Serge Doucet, Jean Grégoire, Philippe L L’allier, Jean-François Tanguay. BACKGROUND METHODS & RESULTS Bioresorbable vascular scaffolds (BVS) have recently been introduced as a novel approach for treatment of coronary artery disease, providing transient vascular support and drug delivery, potentially restoring the vascular physiology after device bioresorption. The theoretical advantages of this novel technology, such as late lumen enlargement, restoration of coronary vasomotion and plaque sealing, make this device appealing for patients with ruptured thin-capped lipid- rich soft plaques in general and thrombotic lesions in acute coronary syndromes. Limited data are currently available on midterm outcomes after implantation of BVS for treatment of acute STEMI. Single-center retrospective study of 56 patients presenting with STEMI and treated with the ABSORB® BVS at the Montréal Heart Institute. Patients were young, had overall equal percentage of cardiovascular risk factors than usually reported in STEMI patients, but more likely pre-treated with Prasugrel (51.8%) or Ticagrelor (39.3%). Most of STEMI patients were TIMI flow 0 (57.1%) and 87.5% were treated with prior thrombectomy. Post-dilation was performed in the large majority of patients (87.5%), more than reported in recent studies. Procedural complications were low. Mean follow-up was 880.8±181.3 days. Clinical outcomes were excellent, with only 1 scaffold thrombosis (1.79%) and 2 target vessel revascularization (3.57%). Scaffold thrombosis was due to discontinuation of all medical therapy 2 months prior the event. In addition, post- dilation was not performed in this patient. Procedural complications No-reflow, n(%) 2 (3.6%) Slow flow, n(%) 6 (10.7%) Dissection, n(%) 4 (7.1%) Distal embolism, n(%) 3 (5.4%) Mid-Term Outcomes Mean Follow-up length 880.8±181.3 Death, n(%) 2 (3.57%) Cardiac death, n(%) 1 (1.79%) Scaffold thrombosis, n(%) Target vessel MI, n(%) Target lesion revascularization, n(%) Target vessel revascularization, n(%) Non-target vessel revascularization Clinical and Procedural Characteristics Data are expressed as mean ± SD or number and proportion, n (%) Medication   Aspirin, n(%) 56 (100%) Clopidogrel, n(%) 5 (8.9%) Prasugrel, n(%) 29 (51.8%) Ticagrelor, n(%) 22 (39.3%) Procedure Thrombectomy, n(%) 49 (87.5%) Pre-dilation, n(%) 45 (80.4%) Direct-stenting, n(%) 11 (19.6%) Pre-dilation balloon diameter per-lesion (mm) 2.59±0.33 Post-dilation, n(%) Post dilation balloon diameter per lesion (mm) 3.24±0.43 Post-dilation balloon/Scaffold size ratio 1.05±0.07 Post-dilation pressure (atm) 18.2±3.24 Overlapping BVS, n(%) 8 (14.3%) Number of scaffold 1.21±0.41 Scaffold length per-lesion (mm) 22.9±7.8 Scaffold diameter per-lesion (mm) 3.06±0.39 Radial approach, n(%) 47 (83.9%) TIMI flow 0, n(%) 32 (57.1%) 1, n(%) 2, n(%) 6 (10.7%) 3, n(%) Pour modifier cette affiche, remplacez l’exemple de contenu par le vôtre. Si vous préférez commencer de zéro, appuyez sur le bouton Nouvelle diapositive sous l’onglet Accueil pour insérer une nouvelle page, puis entrez votre texte et vos images dans les espaces réservés vides. Si vous avez besoin d’espaces réservés supplémentaires pour les titres, les sous-titres ou le corps de texte, copiez un des espaces réservés existants, puis faites glisser le nouveau. Fluoroscopic and OCT view of ABSORB BVS® in STEMI patient A. Coronary angiography with critical thrombotic stenosis of proximal LAD. B. OCT demonstrated a ruptured plaque beginning proximal from the diagonal branch. C. Maximal thrombus burden was detected just proximal from the diagonal branch. D. 3.5/28mm ABSORB BVS was implanted. E&F. Optimal scaffold apposition and sealing of the ruptured plaque AIMS We sought to assess the safety and efficacy of the ABSORB Bioresorbable Scaffold®, in patients presenting with ST-segment elevation myocardial infarction at the Montréal Heart Institute, in Montréal between April 2013 and April 2014. Age (year) 58,2±11,7 Male, n(%) 38 (67.9%) Diabetes, n(%) 7 (12.5%) Hypertension, n(%) 21 (37.5%) Dyslipidemia, n(%) 27 (48.2%) Smoking history, n(%) 32 (57.1%) Obesity, n(%) 23 (41.1%) Previous MI, n(%) 1 (1.8%) Previous PCI, n(%) 4 (7.1%) Previous CABG, n(%) Previous Stroke, n(%) 0 (0%) Kidney disease, n(%) Killip class 1.1±0.44 Culprit vessel   LM, n(%) LAD, n(%) 22 (39.3%) RCA, n(%) LCx, n(%) 12 (21.4%) ABSORB Bioresorbable Scaffold®, Abbott Vascular Poly (L-lactide) Everolimus Eluting Scaffold Conclusions Our findings suggest that the use of the ABSORB® BVS in STEMI patients is safe, with good mid-term clinical outcomes when appropriately implanted with careful lesion preparation and post-dilation, and treated with more potent antiplatelet therapy. Further evaluation in large randomized controlled trials is needed. The authors report no conflict of interest

Background ABSORB Bioresorbable Scaffold®, Abbott Vascular Poly (L-lactide) Everolimus Eluting Scaffold Bioresorbable vascular scaffolds (BVS) have recently been introduced as a novel approach for treatment of coronary artery disease, providing transient vascular support and drug delivery, potentially restoring the vascular physiology after device bioresorption. The theoretical advantages of this novel technology, such as late lumen enlargement, restoration of coronary vasomotion and plaque sealing, make this device appealing for patients with ruptured thin-capped lipid- rich soft plaques in general and thrombotic lesions in acute coronary syndromes. Limited data are currently available on midterm outcomes after implantation of BVS for treatment of acute STEMI.

Aims We sought to assess the safety and efficacy of the ABSORB Bioresorbable Scaffold®, in patients presenting with ST-segment elevation myocardial infarction at the Montréal Heart Institute, between April 2013 and April 2014.

Clinical and Procedural Characteristics Methods & Results Single-center retrospective study of 56 patients presenting with STEMI and treated with the ABSORB® BVS at the Montréal Heart Institute. Clinical and Procedural Characteristics Data are expressed as mean ± SD or number and proportion, n (%) Medication   Aspirin, n(%) 56 (100%) Clopidogrel, n(%) 5 (8.9%) Prasugrel, n(%) 29 (51.8%) Ticagrelor, n(%) 22 (39.3%) Procedure Thrombectomy, n(%) 49 (87.5%) Pre-dilation, n(%) 45 (80.4%) Direct-stenting, n(%) 11 (19.6%) Pre-dilation balloon diameter per-lesion (mm) 2.59±0.33 Post-dilation, n(%) Post dilation balloon diameter per lesion (mm) 3.24±0.43 Post-dilation balloon/Scaffold size ratio 1.05±0.07 Post-dilation pressure (atm) 18.2±3.24 Overlapping BVS, n(%) 8 (14.3%) Number of scaffold 1.21±0.41 Scaffold length per-lesion (mm) 22.9±7.8 Scaffold diameter per-lesion (mm) 3.06±0.39 Radial approach, n(%) 47 (83.9%) TIMI flow 0, n(%) 32 (57.1%) 1, n(%) 2, n(%) 6 (10.7%) 3, n(%) Age (year) 58,2±11,7 Male, n(%) 38 (67.9%) Diabetes, n(%) 7 (12.5%) Hypertension, n(%) 21 (37.5%) Dyslipidemia, n(%) 27 (48.2%) Smoking history, n(%) 32 (57.1%) Obesity, n(%) 23 (41.1%) Previous MI, n(%) 1 (1.8%) Previous PCI, n(%) 4 (7.1%) Previous CABG, n(%) Previous Stroke, n(%) 0 (0%) Kidney disease, n(%) Killip class 1.1±0.44 Culprit vessel   LM, n(%) LAD, n(%) 22 (39.3%) RCA, n(%) LCx, n(%) 12 (21.4%)

Methods & Results Procedural complications were low. Fluoroscopic and OCT view of ABSORB BVS® in STEMI patient A. Coronary angiography with critical thrombotic stenosis of proximal LAD. B. OCT demonstrated a ruptured plaque beginning proximal from the diagonal branch. C. Maximal thrombus burden was detected just proximal from the diagonal branch. D. 3.5/28mm ABSORB BVS was implanted. E&F. Optimal scaffold apposition and sealing of the ruptured plaque No-reflow, n(%) 2 (3.6%) Slow flow, n(%) 6 (10.7%) Dissection, n(%) 4 (7.1%) Distal embolism, n(%) 3 (5.4%) Procedural complications were low. Mean follow-up was 880.8±181.3 days

Methods & Results Clinical outcomes were excellent, with only 1 scaffold thrombosis (1.79%) and 2 target vessel revascularization (3.57%). Scaffold thrombosis was due to discontinuation of all medical therapy 2 months prior the event. In addition, post-dilation was not performed in this patient. Mid-Term Outcomes Mean Follow-up length 880.8±181.3 Death, n(%) 2 (3.57%) Cardiac death, n(%) 1 (1.79%) Scaffold thrombosis, n(%) Target vessel MI, n(%) Target lesion revascularization, n(%) Target vessel revascularization, n(%) Non-target vessel revascularization

Conclusions Our findings suggest that the use of the ABSORB® BVS in STEMI patients is safe, with good mid-term clinical outcomes when appropriately implanted with careful lesion preparation and post- dilation, and treated with more potent antiplatelet therapy. Further evaluation in large randomized controlled trials is needed.

MID-term outcomes of the ABSORB® bioresorbable vascular Scaffold in STEMI patients : initial experience – the MIDAS-STEMI study Fabien Picard, Quentin de Hemptinne Hung Q Ly, Reda Ibrahim, Pierre de Guise, Anita W Asgar, Jean-François Dorval, Marc E Jolicoeur, Serge Doucet, Jean Grégoire, Philippe L L’allier, Jean-François Tanguay. BACKGROUND METHODS & RESULTS Bioresorbable vascular scaffolds (BVS) have recently been introduced as a novel approach for treatment of coronary artery disease, providing transient vascular support and drug delivery, potentially restoring the vascular physiology after device bioresorption. The theoretical advantages of this novel technology, such as late lumen enlargement, restoration of coronary vasomotion and plaque sealing, make this device appealing for patients with ruptured thin-capped lipid- rich soft plaques in general and thrombotic lesions in acute coronary syndromes. Limited data are currently available on midterm outcomes after implantation of BVS for treatment of acute STEMI. Single-center retrospective study of 56 patients presenting with STEMI and treated with the ABSORB® BVS at the Montréal Heart Institute. Patients were young, had overall equal percentage of cardiovascular risk factors than usually reported in STEMI patients, but more likely pre-treated with Prasugrel (51.8%) or Ticagrelor (39.3%). Most of STEMI patients were TIMI flow 0 (57.1%) and 87.5% were treated with prior thrombectomy. Post-dilation was performed in the large majority of patients (87.5%), more than reported in recent studies. Procedural complications were low. Mean follow-up was 880.8±181.3 days. Clinical outcomes were excellent, with only 1 scaffold thrombosis (1.79%) and 2 target vessel revascularization (3.57%). Scaffold thrombosis was due to discontinuation of all medical therapy 2 months prior the event. In addition, post- dilation was not performed in this patient. Procedural complications No-reflow, n(%) 2 (3.6%) Slow flow, n(%) 6 (10.7%) Dissection, n(%) 4 (7.1%) Distal embolism, n(%) 3 (5.4%) Mid-Term Outcomes Mean Follow-up length 880.8±181.3 Death, n(%) 2 (3.57%) Cardiac death, n(%) 1 (1.79%) Scaffold thrombosis, n(%) Target vessel MI, n(%) Target lesion revascularization, n(%) Target vessel revascularization, n(%) Non-target vessel revascularization Clinical and Procedural Characteristics Data are expressed as mean ± SD or number and proportion, n (%) Medication   Aspirin, n(%) 56 (100%) Clopidogrel, n(%) 5 (8.9%) Prasugrel, n(%) 29 (51.8%) Ticagrelor, n(%) 22 (39.3%) Procedure Thrombectomy, n(%) 49 (87.5%) Pre-dilation, n(%) 45 (80.4%) Direct-stenting, n(%) 11 (19.6%) Pre-dilation balloon diameter per-lesion (mm) 2.59±0.33 Post-dilation, n(%) Post dilation balloon diameter per lesion (mm) 3.24±0.43 Post-dilation balloon/Scaffold size ratio 1.05±0.07 Post-dilation pressure (atm) 18.2±3.24 Overlapping BVS, n(%) 8 (14.3%) Number of scaffold 1.21±0.41 Scaffold length per-lesion (mm) 22.9±7.8 Scaffold diameter per-lesion (mm) 3.06±0.39 Radial approach, n(%) 47 (83.9%) TIMI flow 0, n(%) 32 (57.1%) 1, n(%) 2, n(%) 6 (10.7%) 3, n(%) Pour modifier cette affiche, remplacez l’exemple de contenu par le vôtre. Si vous préférez commencer de zéro, appuyez sur le bouton Nouvelle diapositive sous l’onglet Accueil pour insérer une nouvelle page, puis entrez votre texte et vos images dans les espaces réservés vides. Si vous avez besoin d’espaces réservés supplémentaires pour les titres, les sous-titres ou le corps de texte, copiez un des espaces réservés existants, puis faites glisser le nouveau. Fluoroscopic and OCT view of ABSORB BVS® in STEMI patient A. Coronary angiography with critical thrombotic stenosis of proximal LAD. B. OCT demonstrated a ruptured plaque beginning proximal from the diagonal branch. C. Maximal thrombus burden was detected just proximal from the diagonal branch. D. 3.5/28mm ABSORB BVS was implanted. E&F. Optimal scaffold apposition and sealing of the ruptured plaque AIMS We sought to assess the safety and efficacy of the ABSORB Bioresorbable Scaffold®, in patients presenting with ST-segment elevation myocardial infarction at the Montréal Heart Institute, in Montréal between April 2013 and April 2014. Age (year) 58,2±11,7 Male, n(%) 38 (67.9%) Diabetes, n(%) 7 (12.5%) Hypertension, n(%) 21 (37.5%) Dyslipidemia, n(%) 27 (48.2%) Smoking history, n(%) 32 (57.1%) Obesity, n(%) 23 (41.1%) Previous MI, n(%) 1 (1.8%) Previous PCI, n(%) 4 (7.1%) Previous CABG, n(%) Previous Stroke, n(%) 0 (0%) Kidney disease, n(%) Killip class 1.1±0.44 Culprit vessel   LM, n(%) LAD, n(%) 22 (39.3%) RCA, n(%) LCx, n(%) 12 (21.4%) ABSORB Bioresorbable Scaffold®, Abbott Vascular Poly (L-lactide) Everolimus Eluting Scaffold Conclusions Our findings suggest that the use of the ABSORB® BVS in STEMI patients is safe, with good mid-term clinical outcomes when appropriately implanted with careful lesion preparation and post-dilation, and treated with more potent antiplatelet therapy. Further evaluation in large randomized controlled trials is needed. The authors report no conflict of interest