Bioresorbable coronary scaffold thrombosis: multicenter comprehensive analysis of clinical presentation, mechanisms, and predictors

Puricel, Serban; Cuculi, Florim; Weissner, Melissa; Schmermun, Axel; Jamshidi, Peiman; Nyffenegger, Tobias; Binder, Harald; Eggebrecht, Holger; Münzel, Thomas; Cook, Stéphane; Gori, Tommaso

doi:10.1016/j.jacc.2015.12.019

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Bioresorbable coronary scaffold thrombosis: multicenter comprehensive analysis of clinical presentation, mechanisms, and predictors

Puricel, Serban Department of Cardiology, University of Fribourg & Hospital Fribourg, Switzerland
Cuculi, Florim Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
Weissner, Melissa Zentrum für Kardiologie, University Hospital Mainz, Mainz, Germany, and German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, Germany
Schmermun, Axel Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany
Jamshidi, Peiman Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
Nyffenegger, Tobias Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland
Binder, Harald Institute of Medical Biostatistics, Epidemiology and Informatics, University Hospital Mainz, Germany
Eggebrecht, Holger Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany
Münzel, Thomas Zentrum für Kardiologie, University Hospital Mainz, Mainz, Germany, and German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, Germany
Cook, Stéphane Department of Cardiology, University of Fribourg & Hospital Fribourg, Switzerland
Gori, Tommaso Zentrum für Kardiologie, University Hospital Mainz, Mainz, Germany, and German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, Germany

01.03.2016

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Journal of the American College of Cardiology. - 2016, vol. 67, no. 8, p. 921–931

English Background Recent reports suggest an elevated incidence of bioresorbable vascular scaffold (BVS) thrombosis (scaffold thrombosis [ScT]).Objectives This study investigated occurrence rates, clinical and angiographic characteristics, and possible mechanisms of ScT in all-comer patients undergoing BVS implantation at 2 German and 2 Swiss hospitals.Methods A total of 1,305 consecutive patients (mean age 64 years, 78% male) who received 1,870 BVS (mean 1.4 ± 0.8 BVS/patient) were enrolled. Clinical/procedural characteristics, mortality, and ScT data at 485 days (range 312 to 652 days) were examined.Results ScT occurred in 42 patients. The incidence of probable and definite ScT was 1.8% at 30 days and 3.0% at 12 months, without differences among centers (p = 0.60). A total of 22 (52%) ScTs presented as ST-segment elevation myocardial infarction and 6 (17%) as sudden cardiac death. In multivariable analysis, ostial lesions (p = 0.049) and impaired left ventricular ejection fraction (p = 0.019) were independently associated with ScT. Nine (21%) of the ScTs occurred in patients who had suspended dual antiplatelet therapy, in 6 cases prematurely. Lower post-procedural minimum lumen and reference vessel diameters were hallmarks of ScT (all p < 0.0001). The risk of ScT appeared to rapidly increase for post-procedural minimum lumen diameters below 2.4 mm (for the 2.5- to 3.0-mm BVS) and 2.8 mm (for the 3.5-mm BVS). When a BVS-specific implantation strategy was implemented, 12-month ScT rates fell from 3.3% to 1.0%, an effect that remained significant when adjusted for multivariable propensity score (p = 0.012; hazard ratio: 0.19; 95% confidence interval: 0.05 to 0.70).Conclusions The 12-month incidence of ScT reached 3% and could be significantly reduced when an optimized implantation strategy was employed. (retrospective multicentric registry and Mainz Intracoronary Database. The Coronary Slow-flow and Microvascular Diseases Registry [MICAT]; NCT02180178)

Faculty

Faculté des sciences et de médecine

Department

Médecine 3ème année

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