Everolimus eluting bioresorbable vascular scaffolds in patients with acute coronary syndromes: Two‐year results from the German‐Austrian ABSORB registry

Abstract

Objectives To identify potential differences in 2‐year outcome between patients who underwent coronary revascularization using bioresorbable vascular scafffolds (BVS) in stable coronary artery disease (CAD) and acute coronary syndromes (ACS). Background Data from randomized trials suggest a significantly higher event rate following coronary revascularization using everolimus‐eluting BVS as compared to new generation drug eluting stents. Whether particular patient subgroups are at increased risk for scaffold thrombosis and target lesion failure (TLF) has not clearly been demonstrated. Methods German‐Austrian ABSORB RegIstRy is a prospective all‐comer multi‐center observational study of consecutive patients who were considered for coronary revascularization with BVS. We compared 1499 patients with stable CAD to 1594 patients with ACS. Endpoints were major adverse cardiac events (MACE), TLF, and scaffold thrombosis. Results While single vessel disease was more prevalent in ACS (46% vs. 37%, p < 0.0001), lesion complexity (B2/C stenosis 37% vs. 36%, bifurcation 2.4% vs. 3.4%, p < 0.05), number of implanted scaffolds/patient (1.34 vs. 1.43), scaffold length (18 vs. 18 mm) or the rate of high pressure postdilatation (68% vs. 70%) did not differ between ACS and stable CAD. Two‐year MACE rates were 11.6% in ACS and 11.4% in stable CAD, TLF occurred in 7.0% versus 7.4% and target vessel revascularization in 8.8 versus 10.2% (n.s. for all). Definite scaffold thrombosis rates were not significantly different (ACS 1.9% vs. stable CAD 2.1%). Conclusion Real‐world 2‐year event rates after coronary revascularization with BVS are not significantly different between individuals with ACS as compared to stable CAD.

Predictors of Adverse Prognosis in Patients With Acute Coronary Syndrome Caused by Plaque Erosion With a Nonstent Strategy

“…The incidence of MACE in the EROSION study was 3.6% at 1‐month follow‐up, 7.5% at 1‐year follow‐up, and 23.1% at 4‐year follow‐up. 6 , 7 Previous studies have reported that the incidence of MACE in patients with ACS after stent treatment is 3% to 6% at 1 month, 15 , 16 6% to 9% at 1 year, 15 , 17 11% to 12% at 2 years, 18 , 19 and 13% at 3 years, 20 , 21 which is lower compared with that in the EROSION study, but this is because none of these studies included rehospitalization because of unstable or progressive angina as MACE. The proportion of these patients is 15.5% in our study.…”