1. Latvian Centre of Cardiology real-life registry
Two-year clinical outcomes after implantation of an
everolimus-eluting bioresorbable scaffold
Changes of platelet reactivity and clopidogrel effectivity during elective percutaneus coronary intervention:
a comparison between design of drug eluting and bare metal stents
I. Briede, K. Spalva, I. Narbute, D. Sondore, I. Kumsars, A. Dombrovskis, G. Latkovskis, K. Trusinskis, S. Jegere, A. Lismanis, K. Dombrovska, A. Rudzitis, K. Strenge, A. Grave, E. Sokolova, A. Erglis Paul Stradins Clinical University Hospital, Latvian Center of Cardiology, Riga, Latvia
Introduction
Objective and Methods
Permanent caging of the vessel with metal is still perceived as a limitation of DES, in that it prevents late luminal enlargement, adaptive shear stress and late expansive remodeling1
BVS, transient scaffolding of the vessel prevents acute closure and recoil, drug elution counteracts neointimal proliferation, and complete bioresorption after two to four years, together with vessel lumen enlargement, plaque/media reduction and vasomotion restoration, finally realises the paradigm of vascular restoration therapy2
The aim of registry data was to evaluate two-year clinical and angiographic outcomes after implantation of everolimus-eluting bioresorbable scaffold (Absorb) from the Latvian centre of cardiology real-life registry
From all patients included between November 2012 and December 2014 in the Latvian centre of cardiology real-life registry, 187 patients with stable angina and acute coronary syndrome were selected
All patients had percutaneous coronary intervention (PCI) following bioresorbable scaffold (Absorb) implantation
During two-years follow up, clinical and angiographic results were analysed; all-cause death, cardiac death, target vessel-related myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), scaffold thrombosis (ST), and cerebrovascular events
Clinical two year follow-up reached 96.2% of patients
Results
The clinical angiographic and procedural characteristics are shown in Table1, 2 and 3, respectively. Clinical follow-up reached 96.2% (n=187) patients. Outcomes of major adverse cardiac events are shown in Table 4. Hospital ST was 0.5% (n=1) due to clopidogrel resistance, early ST in fifth day was 0.5% (n=1). All statistical analyses were performed using SPSS version 24.0 software (IBM SPSS, Corp., Armonk, NY). Continuous variables were expressed as mean and standard deviation (SD)
Table 3. Procedural Characteristics
Table 1. Baseline Clinical Characteristics
Table 2. Angiographic Characteristics
N=187 patients procedural data: n (%)
Radial approach
142 (75,9)
IVUS use
32 (17,1)
OCT use
31 (16,6)
GP-IIbIIIa inhibitors
112 (59,9)
Pre-dilatation:
Regular balloon
Cutting balloon
173 (92,5)
86 (50,3)
87 (49,7)
Mean pre-dilatation balloon diameter (mm) , mean  SD
2,92 ± 0,48
Mean pre-dilatation balloon length (mm) , mean  SD
15,80 ± 8,66
Mean scaffold length (mm) , mean  SD
20,10 ± 6,48
Mean scaffold diameter (mm) , mean  SD
3,17 ± 0,36
Post-dilatation
Post-dilatation balloon diameter (mm) , mean  SD
3,46 ± 0,41
Post-dilatation balloon maximal atmospheres
17,11 ± 3,34
N=187 patients clinical characteristics: n (%)
Males
147 (78,6)
Mean age (years), mean  SD
56,74 ± 11,85
Arterial hypertension
151 (80,7)
Dyslipidemia
129 (69,0)
Diabetes mellitus
33 (17,6)
Smoking
29 (15,5)
Previous myocardial infarction
65 (34,8)
Previous PCI
77 (41,2)
CABG
5 (2,7)
Previous cerebral infarction
10 (5,3)
Peripheral artery disease
8 (4,3)
Chronic kidney disease
Chronic heart failure
73 (39,0)
Asymptomatic
4 (2,1)
Stable angina
148 (79,1)
Unstable angina
11 (5,9)
NSTEMI
6 (3,2)
STEMI
18 (9,6)
N=187 patients angiographic data: n (%)
Multi-vessel disease
115 (61,5)
Target lesion vessel:
Left main (LM)
Left anterior descending (LAD)
Left circumflex (LCX)
Right coronary artery (RCA)
First diagonal brunch (D1)
Marginal brunch (OM)
Ramus intermedius (RIM)
2 (1,1)
93 (49,7)
27 (14,4)
47 (25,1)
6 (3,2)
7 (3,8)
4 (2,1)
Target lesion localization:
Ostial
Proximal
Middle
Distal
34 (18,2)
123 (65,8)
113 (60,4)
24 (12,8)
True bifurcation lesion
28 (14,9)
Table 4. Clinical and angiographic major adverse cardiac events (MACE) at two year follow up
Conclusions
Bioresorbable scaffolds showed acceptable rates of target lesion revascularization and scaffold thrombosis at mid-term follow-up in stable angina and acute coronary syndrome patients. Clinical, lesion and procedural factors did not show significant difference between patients with and without target lesion failure
References:
Funding:
This study was supported in part by Latvian National Research Program "Biomedicine for Public Health" (BIOMEDICINE) and by grant from corporation „Sistemu Inovacijas”
Ieva Briede
1 Capodanno D., et al. Eurointervention. 2015; 10(10):
2 Onuma Y, Serruys PW. Circulation. 2011;123: