The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Letter to the editor

Definite and probable bioresorbable scaffold thrombosis in stable and ACS patients

EuroIntervention 2015;11:e1-e3 - published online ahead of print September 2014. DOI: 10.4244/EIJY14M09_08

Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands

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We read with great interest the recent report by Capodanno et al1. In the European multicentre GHOST-EU registry, the authors reported that the rate of definite/probable scaffold thrombosis was 2.1% (definite scaffold thrombosis: 1.8%, probable scaffold thrombosis: 0.3%) in an all-comers population at six months. More specifically, the rate of definite/probable scaffold thrombosis was 1.4% (9/626) in stable/silent angina pectoris (SAP), 2.5% (14/563) in acute coronary syndrome (ACS) and 2.1% (4/192) in ST-segment elevation myocardial infarction (STEMI). This publication prompted us to review the rates of scaffold thrombosis in all-comers, SAP, ACS and STEMI either reported so far in peer review journals or presented at international meetings.

Table 1 summarises the rate of scaffold thrombosis in each individual report. Excluding the GHOST-EU registry, the rate of definite/probable scaffold thrombosis was 0.89% in all-comers, 0.68% in SAP, 1.71% in ACS and 0.67% in STEMI. There were 25 definite and two probable scaffold thromboses. Out of 27 patients with scaffold thrombosis, two had acute (≤24 hours after procedure) thrombosis (0.06%) and 15 had subacute after one day (≤1 month after procedure) thrombosis (0.48%). Premature discontinuation of dual antiplatelet therapy (DAPT) or resistance to clopidogrel at the time of scaffold thrombosis was documented in 29.4% patients (5/17). The rate of scaffold thrombosis when the GHOST-EU registry is added to the series is tabulated at the bottom of Table 1. Potential aetiological causes of scaffold thrombosis could be: 1) suboptimal implantation resulting in underexpansion/acute incomplete strut apposition2-4 or acute disruption of struts5; 2) platelet activation due to low shear stress created by the relatively thick strut6; 3) delayed tissue coverage in an overlapped segment7-9; 4) discontinuation of DAPT or resistance to DAPT9.

In the first randomised comparison of ABSORB II10, the rate of definite scaffold/stent thrombosis was 0.6% in Absorb (one acute and one subacute case) and 0% in XIENCE (p=1.0), and the rate of definite/probable scaffold/stent thrombosis was 0.9% in Absorb and 0% in XIENCE (p=0.55)10.

Further randomised studies may or may not confirm these scaffold thrombosis rates in the future11,12.

Conflict of interest statement

The authors have no conflicts of interest to declare.

References

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