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

Very long-term outcome of ABSORB bioresorbable vascular scaffold vs. everolimus-eluting metallic stent in ST-segment elevation myocardial infarction: 5-year results of the BVS-EXAMINATION study.

DOI: 10.4244/EIJ-D-19-00773

1. Cardiovascular institute, Hospital Clinic. University or Barcelona, IDIBAPS, Spain, Spain
2. Medizinische Klinik und Poliklinik für Kardiologie, Angiologie und innere Intensivmedizin, Mainz, Germany.
3. Cardiocenter, Third Faculty of Medicine, Charles University in Prague, University Hospital Kralovske Vinohrady, Prague, Czech Republic.
4. Institute of Cardiology, Hospital of Bellvitge, Barcelona, Spain
5. Cardiology Department, Interventional Cardiology Unit, Virgen de la Arrixaca Hospital, Murcia, Spain.
6. Cardiovascular Institute, Hospital Clinic. University of Barcelona, IDIBAPS. Spain.
7. Institute of Cardiology, Hospital of Bellvitge, Barcelona, Spain.
8. Imperial College, London, UK

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Aims: to compare 5-year clinical outcomes between everolimus-eluting bioresorbable scaffold (BRS) vs. everolimus-eluting metallic stent (EES) in STEMI patients.

Methods and results: This observational and retrospective study included 235 consecutive STEMI patients treated by BRS, compared with 235 STEMI patients treated with EES from the EXAMINATION trial, by applying propensity score matching. Primary endpoint was a device-oriented endpoint (DOCE), including cardiac death, target vessel myocardial infarction and target lesion revascularization at 5-year follow-up.Device thrombosis, according to the ARC criteria, was also evaluated.Optical coherence tomography (OCT) analysis was also performed at 5-year in event-free BRS patients. The cumulative incidence of 5-year DOCE was higher in BRS as compared to EES group (13.2% vs. 7.6%, HR [95%CI] 1.87 [0.94 – 3.44], p=0.071), mainly driven by higher rate of TLR (7.6% vs. 1.7%, HR [95%CI] 1.15 [0.44 – 2.30], p=0.004). Five-year definite BRS thrombosis rate was also higher as compared to EES (4.2% vs. 1.2%, HR [95%CI] 3.49 [0.95 – 12.82], p=0.054. Optical coherence tomography analysis showed high incidence of neo-atherosclerosis in BRS group.

Conclusions: Five-year event risk was higher with BRS vs EES in STEMI. This suggests that the probability of obtaining favorable results at very long-term follow-up is low. Whether better results will be obtained with new generation BVS remains to be determined.

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