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

PROcedure related microvascular ACTIVation in long lEsions treated with bioresorbable vascular scaffold versus everolimus-eluting stent implantation (PROACTIVE trial)

EuroIntervention 2019, just accepted article published in May 2019. DOI: 10.4244/EIJ-D-18-01138

1. Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium, Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy,", BELGIUM, 2. Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium, Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy,", 3. Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium, 4. Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium, 5. Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium, 6. University Heart Center Graz, Medical University of Graz, Graz, Austria, 7. Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium, 8. Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium, 9. Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium, 10. Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium, 11. Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium, 12. Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium, 13. Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium, Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy, BELGIUM
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As a public service to our readership, this article - peer reviewed by the Editors of EuroIntervention - has been published immediately upon acceptance as it was received. The content of this article is the sole responsibility of the authors, and not that of the journal or its publishers. To read the full content of this article, please download the PDF.

Aims: Significant platelet activation after long stented coronary segments has been associated with peri-procedural microvascular impairment and myonecrosis. In long lesions treated either with everolimus-eluting bioresorbable vascular scaffold (BVS) or everolimus-eluting stent (EES), we investigated (a) procedure-related microvascular impairment, and (b) relationship of platelet activation with microvascular function and related myonecrosis.

Methods and results: Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomized 1:1 either to BVS or EES. Primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Peri-procedural myonecrosis was assessed by high sensitivity-cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer™. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of Δ cIMR (p= 0,04). Hs-ADP was not different between the 2 groups at different time points. Hs-cTnT significantly increased after PCI, without difference between the groups.

Conclusions: In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or peri-procedural myonecrosis.

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