Author + information
- Mariusz Tomaniak1,
- Cordula Felix2,
- Jiang Ming Fam2,
- Robert-Jan van Geuns2,
- Nicolas Van Mieghem2,
- Evelyn Regar2,
- Joost Daemen2,
- Felix Zijlstra2 and
- Roberto Diletti2
Implantation of bioresorbable vascular scaffold (BVS) in acute coronary syndromes (ACS), with the presence of vasoconstriction and thrombotic material, might be associated with device undersizing and malapposition after thrombus dissolution. On the other hand, the implantation of oversized BVS has been reported to increase the risk of acute and late adverse events. The study aims to assess the impact of scaffold oversizing, underexpansion and postdilatation on acute angiographic and one year clinical outcomes in patients with ACS treated with bioresorbable devices.
Patient data were pooled from the BVS STEMI First and BVS Expand studies. Scaffold oversizing was defined as scaffold-to-vessel diameter ratio >1.2. Scaffold underexpansion was evaluated analyzing final MLD, %scaled residual diameter stenosis (%scDS), maximal footprint (MFP). Procedural characteristics and one-year clinical outcomes were reported.
A total of 285 ACS patients treated with BVS implantation were evaluated. Scaffold oversizing was present in 159 patients (185 lesions). In the oversizing group was observed a higher rate of underexpansion in terms of final MLD (2.2±0.4 vs 2.5±0.4, p=0.0001), %scDS (28.1%±9.7 vs 21.1% ±11.3, p=0.0001) and MFP (37.4%±7.0 vs 33.6%±6.0, p=0.0001) as compared to non-oversizing group (126 patients, 151 lesions). In the oversizing group a higher relative gain (0.7±0.3 vs 0.6±0.2, p=0.003) was observed indicating stronger vessel wall stretching. Scaffold oversizing was associated with a higher rate of MACE (8.2% vs. 1.6%, p=0.013), myocardial infarction (6.9% vs. 1.6%, p=0.032), target lesion revascularization (5.0% vs. 0.8%, p=0.044) and target lesion failure (6.9% vs. 0.8%, p=0.011) at one-year follow-up. On the contrary, there was no impact of postdilatation on the clinical outcomes in this population.
Oversized scaffold implantation in patients with ACS is often associated with both increased vessel injury and underexpansion as expressed by scaled residual diameter stenosis, scaffold maximal footprint and minimal lumen diameter and could be related to a higher rate of adverse clinical events at one year.
CORONARY: Bioresorbable Vascular Scaffolds