Five-Year Optical Coherence Tomography in Patients With ST-Segment–Elevation Myocardial Infarction Treated With Bare-Metal Versus Everolimus-Eluting Stents

Abstract

P ercutaneous coronary intervention with stent implantation is the standard of care in patients with ST-segmentelevation myocardial infarction (STEMI). 1 Patients treated with first-generation drug-eluting stents (DES) had lower rate of target lesion revascularization than patients treated with bare-metal stents (BMS) at 5 years.2 However, this reduction was only observed during the first year after stent implantation. The analysis of the subsequent years (from 1-5 years) showed higher rate of target lesion revascularization in the group treated with first-generation DES than in the group treated with BMS. This was caused by a higher incidence of very-late stent thrombosis (ST) in the group treated with firstgeneration DES.2 Moreover, it is also remarkable that the incidence of late ST has no attenuation neither with DES nor with BMS at very long-term follow-up (>5 years).

MAGnesium‐based bioresorbable scaffold and vasomotor function in patients with acute ST segment elevation myocardial infarction: The MAGSTEMI trial: Rationale and design

“…Primary percutaneous coronary intervention (PPCI) is the well‐established treatment of choice for the majority of patients presenting with acute ST elevation myocardial infarction (STEMI) and previous trials have demonstrated its superiority to conventional thrombolytic treatment . Although introduction of metallic drug‐eluting stents (DES) reduced neointimal hyperplasia, target lesion revascularization and stent thrombosis as compared to metallic stents, its impaired endothelialization with risk of very late stent thrombosis is of particular concern in patients undergoing PPCI …”

“…1 Although introduction of metallic drug-eluting stents (DES) reduced neointimal hyperplasia, target lesion revascularization and stent thrombosis as compared to metallic stents, 2 its impaired endothelialization with risk of very late stent thrombosis is of particular concern in patients undergoing PPCI. 3,4 Fully bioresorbable scaffold (BRS) may help overcome these DES very late concerns, by disappearing from coronary vessel and releasing therefore the coronary artery from the metallic caging: the vessel may so recover pulsatility and become responsive to shear stress and physiological cyclic strain. 5 This was initially corroborated in the first ABSORB trials using the fully bioresorbable poly-lactideacid (PLLA) everolimus-eluting scaffold (Abbott Vascular, Santa Clara, CA) by coronary vasomotion testing, which suggests complete restoration of functional and uninterrupted endothelial lining capable of producing anti-thrombotic nitric oxide within the scaffolded vessel area.…”

Coronary Stent Implantation Poses Lifelong Risk of Severe Infection or Even Death

“…Endothelialization of the stent's strut appears to be protective against hematogenous bacterial dissemination 3) . However, even 5 years after stent implantation, complete endothelialization was achieved only in 71% of patients who underwent coronary interventions with BMS, and the percentage was much lower (42%) in patients with DES 4) . Furthermore, surgeons often encounter coronary stents protruding into the aortic root without endothelialization when they are implanted in the ostial lesion 5) .…”

Long-term clinical results of biodegradable vascular scaffold ABSORB BVS™ using the PSP-technique in patients with acute coronary syndrome

“…Bioresorbable vascular scaffolds (BVSs) are a first-generation technology introduced to overcome the limitations of metallic stents [1,2]. Unfortunately, recent reports of randomized trials revealed several negative results compared with drug eluting stents (DESs) [3][4][5], especially a higher rate of target-vessel myocardial infarction and scaffold thrombosis [6].…”