Clinical Comparison With Short-Term Follow-Up of Bioresorbable Vascular Scaffold Versus Everolimus-Eluting Stent in Primary Percutaneous Coronary Interventions

Introduction: Primary percutaneous coronary intervention (PCI) represents the gold-standard treatment for patients presenting with an ST-elevation myocardial infarction (STEMI). Acute myocardial infarction is a complex clinical scenario, and an appropriate therapeutic approach could be represented by a balanced integration between healthcare system and medical competence. Areas covered: In this review we discuss how a primary PCI network, and the new therapeutic options could be coupled in order to obtain improved clinical outcomes. The present report will focus on three main issues related to STEMI patients, namely, out of hospital management, primary PCI and pharmacological treatment. Expert commentary: A possible correct approach to a patient presenting a STEMI could be considered as a stepwise process, given by 5 steps: reducing the time to reperfusion; dual antiplatelet administration; radial access; new generation drug eluting stent implantation; long term management. ARTICLE HISTORY

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“…No significant differences were observed also in clinical secondary end points, confirming previous observational results [52][53][54][55].…”

Section: Stent Typesupporting

confidence: 80%

Current and novel approaches to treat patients presenting with ST elevation myocardial infarction

Mancone

Mieghem

Zijlstra

et al. 2016

Expert Review of Cardiovascular Therapy

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“…In addition, it could be more useful in complex lesions or bifurcations [18]. Several studies have presented high variability in intravascular imaging utilization during PCI with BVS deployment [9, 19–21]. Our registry showed lower frequency of OCT and IVUS utilization in comparison with most of the above-mentioned studies.…”

Section: Discussionmentioning

confidence: 72%

Patient profile and periprocedural outcomes of bioresorbable vascular scaffold implantation in comparison with drug-eluting and bare-metal stent implantation. Experience from ORPKI Polish National Registry 2014–2015

Rzeszutko¹,

Tokarek²,

Siudak³

et al. 2016

pwki

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IntroductionThere are limited data on the comparison of bioresorbable vascular scaffold (BVS) and drug-eluting stent (DES)/bare-metal stent (BMS) implantation in an unselected population of patients with coronary artery disease.AimTo compare the periprocedural outcomes and patient profile of BVS and DES/BMS implantation in an all-comer population from the ORPKI Polish National Registry.Material and methodsA total of 141,324 consecutive patients from 151 invasive cardiology centers in Poland were included in this prospective registry between January 2014 and June 2015. Periprocedural data on patients with at least one BVS (Absorb, Abbott Vascular, Santa Clara, CA, USA), DES or BMS (all available types) implantation in de novo lesions during index percutaneous coronary intervention for stable angina (SA) or acute coronary syndrome were collected.ResultsBioresorbable vascular scaffold was the most often used in patients with SA, in single-vessel disease and in younger male patients. Bioresorbable vascular scaffold implantation was significantly more often associated with periprocedural administration of ticagrelor/prasugrel (6.8% vs. 3.6%; p = 0.001) and use of intravascular ultrasound and optical coherence tomography in comparison with the DES/BMS group (2.8% vs. 0.6% and 1.8% vs. 0.1%, respectively; p = 0.001 for both). The incidence of periprocedural death was significantly lower in the BVS group than the DES/BMS group (0.04% vs. 0.32%; p = 0.02), but this difference was no longer significant after adjustment for covariates. On the other hand, coronary artery perforation occurred significantly more often during BVS delivery (0.31% vs. 0.12%; p = 0.01), and BVS implantation was identified as an independent predictor of coronary artery perforation in multivariate logistic regression analysis (OR = 6.728, 95% CI: 2.394–18.906; p = 0.001).ConclusionsPatients treated with BVS implantation presented an acceptable safety and efficacy profile in comparison with the DES/BMS group. However, lower risk patients were the most frequent candidates for BVS implantation.

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Alfonso¹,

Cuesta²,

Bastante³

et al. 2016

J. Thorac. Dis.

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Bioresorbable vascular scaffolds (BVS) represent a disruptive technology that has caused a new revolution in interventional cardiology. BVS appear to be particularly appealing in patients presenting with an acute myocardial infarction (MI). The available evidence on the value of BVS implantation in this challenging scenario is very promising but still limited. Results come from preliminary small observational studies, prospective registries that include a control group, and from scarce randomized clinical trials with surrogate mechanistic or angiographic primary end-points. Further studies, powered for clinical endpoints, are required to establish the relative safety and efficacy of BVS vs. new-generation metallic drug-eluting stents (DES) in patients with ST-segment elevation acute MI.

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Clinical Comparison With Short-Term Follow-Up of Bioresorbable Vascular Scaffold Versus Everolimus-Eluting Stent in Primary Percutaneous Coronary Interventions

Cited by 36 publications

References 21 publications

Current and novel approaches to treat patients presenting with ST elevation myocardial infarction

Current and novel approaches to treat patients presenting with ST elevation myocardial infarction

Patient profile and periprocedural outcomes of bioresorbable vascular scaffold implantation in comparison with drug-eluting and bare-metal stent implantation. Experience from ORPKI Polish National Registry 2014–2015

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

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