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Lesion impacts on long-term outcomes in patients implanted with bioresorbable vascular scaffold
Yi-Chih Wang1, Hsien-Li Kao1, Cho-Kai Wu1
1Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Insights
Long-term outcomes for bioresorbable vascular scaffolds (BVS) in complex coronary lesions were comparable to simpler lesions. However, ACC/AHA type C lesions showed increased risks of target lesion revascularization and failure.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomaterials Science
Background:
- Bioresorbable vascular scaffolds (BVS) are used for complex coronary lesions.
- Real-world data on long-term BVS outcomes in complex versus simple lesions is limited.
Purpose of the Study:
- To evaluate and compare the long-term clinical outcomes of BVS implantation in complex coronary lesions versus non-complex lesions.
- To identify factors influencing long-term outcomes after BVS implantation.
Main Methods:
- Analysis of 457 patients with 714 BVS implanted in 529 lesions, with a median follow-up of 32.7 months.
- Complex lesions defined by specific criteria (ACS, CTO, bifurcation, ISR, etc.).
- Comparison of outcomes between complex and non-complex lesion groups using Cox regression analysis.
Main Results:
- Complex group had more comorbidities and received more/longer BVS.
- Long-term target lesion revascularization (TLR) and target lesion failure (TLF) rates were similar between complex and non-complex groups.
- ACC/AHA type C lesions were independently associated with higher risks of TLR and TLF.
Conclusions:
- BVS demonstrate comparable long-term safety and efficacy in complex and non-complex coronary lesions.
- Lesion complexity, specifically ACC/AHA type C, remains a significant predictor of adverse long-term outcomes (TLR, TLF) after BVS implantation.
Background:
Bioresorbable vascular scaffold (BVS) had been implanted to several kinds of complex coronary lesions in real-world practice. We tested if long-term outcomes of BVS for complex lesions would be worse than that for relatively simple lesions.
Methods:
We analyzed 457 patients (59 ± 12 years, 87% male) with 714 BVS implanted for their 529 lesions and median follow-up of 32.7 (26.8-39.3) months. Complex group (N = 284) was defined as those with BVS for acute coronary syndrome, chronic total occlusion, bifurcation/ostial lesions, instent restenosis/hybrid with metallic stents, diffuse lesions (overlapped by 2 BVS with each ≧ 18 mm), venous graft/left main lesions, or lesions after rotablation. We compared their outcomes with the remaining 173 patients as non-complex group.
Results:
The complex group had more chronic kidney disease (7% vs. 2%), multivessel disease (78% vs. 65%), use of intravascular imaging (40% vs. 23%), and more BVS (1.8 ± 0.9 vs. 1.1 ± 0.3) with longer total lengths (47 ± 22 vs. 29 ± 8 mm) implanted than non-complex group (all p < 0.05). However, the long-term target lesion revascularization (TLR) or target lesion failure (TLF) was similar (log rank p > 0.05) between the two groups. Multivariate Cox regression analyses showed BVS for ACC/AHA type C lesions was independently associated with higher risks of TLR (hazard ratio: 2.7, 95% CI = 1.1-6.6) and TLF (hazard ratio: 2.6, 95% CI = 1.1-6.3).
Conclusion:
Comparable outcomes were found between BVS for complex and non-complex lesion category. However, higher risks of TLR and TLF for type C lesions still suggested the prognostic impact of lesion complexity on long-term outcomes of BVS.
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