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Bioresorbable vascular scaffolds in acute ST-segment elevation myocardial infarction: a prospective multicentre study
Viktor Kočka1, Martin Malý, Petr Toušek
1Cardiocenter, Third Faculty of Medicine, Charles University in Prague, University Hospital Kralovske Vinohrady, Srobarova 60, 100 34 Prague 10, Czech Republic.
Insights
Bioresorbable vascular scaffolds (BVSs) are feasible and safe for treating acute ST-segment elevation myocardial infarction (STEMI). This study shows excellent procedural outcomes and encouraging early clinical results for BVS implantation in STEMI patients.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomaterials Science
Background:
- Bioresorbable vascular scaffolds (BVSs) have shown promise in chronic coronary artery disease.
- Their use in acute ST-segment elevation myocardial infarction (STEMI) has not been extensively studied.
- This research addresses the gap in understanding BVS safety and efficacy in the STEMI population.
Purpose of the Study:
- To evaluate the feasibility and safety of BVS implantation during primary percutaneous coronary intervention (p-PCI) in patients with acute STEMI.
- To assess procedural success and early clinical outcomes of BVS in this patient group.
Main Methods:
- A prospective, multicentre study involving 142 patients undergoing p-PCI for STEMI.
- 41 patients met criteria for BVS implantation, with a substudy using optical coherence tomography (OCT) for detailed analysis.
- Clinical outcomes were compared between the BVS group and a control group with metallic stents.
Main Results:
- BVS implantation achieved high device success (98%) and restored TIMI 3 flow in 95% of patients.
- OCT analysis revealed excellent scaffold apposition (1.1% malapposition) and minimal, clinically silent edge dissections (38%).
- Event-free survival was comparable between the BVS (95%) and control (93%) groups, indicating similar early clinical safety.
Conclusions:
- BVS implantation is a feasible and safe strategy for patients with acute STEMI undergoing p-PCI.
- Angiographic and OCT findings demonstrate excellent procedural results.
- The early clinical outcomes are encouraging, supporting the use of BVS in this acute setting.
Aims:
Bioresorbable vascular scaffolds (BVSs) have been studied in chronic coronary artery disease, but not in acute ST-segment elevation myocardial infarction (STEMI). This prospective multicentre study analysed the feasibility and safety of BVS implantation during primary percutaneous coronary intervention (p-PCI) in STEMI.
Methods And Results:
Bioresorbable vascular scaffold implantation became the default strategy for all consecutive STEMI patients between 15 December 2012 and 30 August 2013. A total of 142 patients underwent p-PCI; 41 of them (28.9%) fulfilled the inclusion/exclusion criteria for BVS implantation. The BVS device success was 98%, thrombolysis in myocardial infarction 3 flow was restored in 95% of patients, and acute scaffold recoil was 9.7%. An optical coherence tomography (OCT) substudy (21 patients) demonstrated excellent procedural results with only a 1.1% rate of scaffold strut malapposition. Edge dissections were present in a 38% of patients, but were small and clinically silent. Reference vessel diameter measured by quantitative coronary angiography was significantly lower than that measured by OCT by 0.29 (±0.56) mm, P = 0.028. Clinical outcomes were compared between BVS group and Control group; the latter was formed by patients who had implanted metallic stent and were in Killip Class I or II. Combined clinical endpoint was defined as death, myocardial infarction, or target vessel revascularization. Event-free survival was the same in both groups; 95% for BVS and 93% for Control group, P = 0.674.
Conclusion:
Bioresorbable vascular scaffold implantation in acute STEMI is feasible and safe. The procedural results evaluated by angiography and OCT are excellent. The early clinical results are encouraging.
