Author + information
- Takeshi Nishi1,
- Kozo Okada2,
- Hideki Kitahara1,
- Masayasu Ikutomi1,
- M. Brooke Hollak1,
- Paul G. Yock1,
- Jeffrey Popma3,
- Hajime Kusano4,
- Wai-Fung Cheong5,
- Krishna Sudhir4,
- Stephen Ellis6,
- Dean Kereiakes7,
- Gregg Stone8,
- Yasuhiro Honda1 and
- Takeshi Kimura9
- 1Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
- 2Yokohama City University Medical Center, Yokohama, Japan
- 3Beth Israel Deaconess Medical Center, Boston, Massachusetts
- 4Abbott Vascular, Santa Clara, California
- 5Abbott Vascular, Los Altos, California
- 6Cleveland Clinic, Cleveland, Ohio
- 7The Christ Hospital, Cincinnati
- 8Cardiovascular Research Foundation, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York
- 9Kyoto University Graduate School of Medicine, Kyoto, Japan
This study aimed to identify the intravascular ultrasound (IVUS) predictors of long-term clinical outcomes following ABSORB bioresorbable vascular scaffold (BVS) implantation from the pooled IVUS substudy cohorts of the ABSORB III and Japan trials.
A total of 298 lesions in 286 patients were enrolled with 2:1 randomization to ABSORB BVS versus cobalt-chromium everolimus-eluting stents. The primary endpoint of this analysis was device-oriented composite endpoint (DOCE), including cardiac death, target vessel-related myocardial infarction, or ischemia-driven target lesion revascularization. The median follow-up duration was 4.0 years.
During follow-up, DOCE occurred in 9.5% of lesions treated with BVS. Among several post-procedural IVUS indexes associated with DOCE, nonuniform device expansion (defined as uniformity index = minimum/maximum device area) (hazard ratio: 0.51 per 0.1 increase [95% confidence interval (CI): 0.34 to 0.76]; p = 0.001) and residual reference plaque burden (hazard ratio: 2.75 per 10% increase [95% CI: 1.60 to 4.74]; p < 0.001) were identified as independent predictors of DOCE by Cox multivariable analysis (Figure).
Nonuniform device expansion and substantial untreated residual plaque in reference segments were associated with long-term adverse events following BVS implantation. Baseline imaging to identify the appropriate device landing zone and procedural imaging to achieve uniform device expansion if possible (e.g., through post-dilatation) may improve clinical outcomes of BVS implantation.
CORONARY: Stents: Bioresorbable Vascular Scaffolds