Bioresorbable vascular scaffolds in acute ST-segment elevation myocardial infarction: a prospective multicentre study 'Prague 19'

Abstract

AimsBioresorbable vascular scaffolds (BVSs) have been studied in chronic coronary artery disease, but not in acute ST-segment elevation myocardial infarction (STEMI). This prospective multicentre study analysed the feasibility and safety of BVS implantation during primary percutaneous coronary intervention (p-PCI) in STEMI.Methods and resultsBioresorbable vascular scaffold implantation became the default strategy for all consecutive STEMI patients between 15 December 2012 and 30 August 2013. A total of 142 patients underwent p-PCI; 41 of them (28.9%) fulfilled the inclusion/exclusion criteria for BVS implantation. The BVS device success was 98%, thrombolysis in myocardial infarction 3 flow was restored in 95% of patients, and acute scaffold recoil was 9.7%. An optical coherence tomography (OCT) substudy (21 patients) demonstrated excellent procedural results with only a 1.1% rate of scaffold strut malapposition. Edge dissections were present in a 38% of patients, but were small and clinically silent. Reference vessel diameter measured by quantitative coronary angiography was significantly lower than that measured by OCT by 0.29 (±0.56) mm, P = 0.028. Clinical outcomes were compared between BVS group and Control group; the latter was formed by patients who had implanted metallic stent and were in Killip Class I or II. Combined clinical endpoint was defined as death, myocardial infarction, or target vessel revascularization. Event-free survival was the same in both groups; 95% for BVS and 93% for Control group, P = 0.674.ConclusionBioresorbable vascular scaffold implantation in acute STEMI is feasible and safe. The procedural results evaluated by angiography and OCT are excellent. The early clinical results are encouraging.

Bioresorbable everolimus-eluting vascular scaffold in patients with ST-segment elevation myocardial infarction: Optical coherence tomography evaluation and clinical outcomes

“…Distal embolization occurred only in 1 (4.3%) case and no-reflow phenomenon in none. These findings are in line with recently published studies in STEMI population treated with the same type of BVS [15,16].…”

“…Success rates were defined as in previous studies with BVS implantation [15,16]. Device success was described as the presence of residual diameter stenosis < 30% of the segment of the culprit lesion, covered by the BVS, assessed by angiographic visual estimation.…”

“…The latter phenomenon is associated with the dissolution of the thrombus sequestrated between the BVS struts and the vessel wall [13,14]. There are only few reports with a comprehensive optical coherence tomography (OCT) evaluation of the BVS implantation in this group of patients [15,16]. To add more data to the current limited body of evidence, we performed a pilot study with a qualitative and quantitative OCT examination to assess vessels' response to the implanted BVS and the performance of the new device in culprit lesions in patients presenting with ST segment elevation myocardial infarction (STEMI).…”

Bioresorbable vascular scaffolds in patients with acute myocardial infarction: a new step forward to optimized reperfusion?

“…Results from available observational studies and randomized clinical trials are reassuring and very promising (16)(17)(18)(19)(20)(21)(22)(23). Rates of early BVS thrombosis in adverse anatomic scenarios, including the presence of a highly thrombogenic milieu, however, appear to be not negligible.…”

Bioresorbable scaffold — A magic bullet for the treatment of coronary artery disease?

“…The everolimus-eluting bioresorbable vascular scaffolds for treatment of patients presenting with ST-segment elevation myocardial infarction (BVS STEMI) study was the first that evaluated BRS use in STEMI (103 The investigators reported good procedural and clinical outcome in these patients, but with stent thrombosis rate of 2.4%, higher than that seen in clinical trials (106). An excellent review of BRS use in STEMI has been published elsewhere (107) and the authors stated that the unique properties of the BRS make STEMI the ideal scenario for BRS implantation.…”