Outcomes of Patients With High‐Risk Plaques Treated With a Bioresorbable Magnesium Scaffold: Insights From the BIOMAG‐I Study

Background Early identification and targeted treatment of coronary lesions at higher risk of future events remains a major unmet need in coronary artery disease research. Invasive treatment of such plaques is controversial. The third‐generation bioresorbable magnesium scaffold (DREAMS 3G) may provide a valuable alternative, but it has not been evaluated in this setting. The BIOMAG‐I study, with comprehensive OCT and IVUS imaging, offers a unique opportunity to investigate high‐risk plaque morphology and its vascular response. Aims We aimed to assess the association between lesions with high‐risk plaque features treated with the DREAMS 3G scaffold and late lumen loss (LLL) at follow‐up. Methods This post‐hoc analysis included patients with stable coronary artery disease and high‐quality intravascular imaging. High‐risk plaque was defined as μFR > 0.80 with PB ≥ 70%. Subgroups were further stratified by the presence of MLA < 4 mm², TCFA < 80 μm, lipid arc >90°, or all combined PB was assessed by IVUS or estimated by OCT when IVUS was unavailable. LLL was measured at 6 and 12 months. Results Of 83 patients, 42 (50.6%) met the definition of μFR > 0.80 with PB ≥ 70%. Within this cohort, 41 also had MLA < 4 mm², 23 had TCFA < 80 μm, 16 had lipid arc ≥ 180°, and 16 presented all four features. LLL remained low in the overall PB ≥ 70% group (0.21 ± 0.29 mm at 6 months; 0.27 ± 0.44 mm at 12 months) and was similarly low or even lower across the additional subgroups, including those with all features combined (0.19 ± 0.21 mm and 0.16 ± 0.19 mm). Conclusions In this sub‐analysis of the BIOMAG‐I trial, the DREAMS 3G bioresorbable magnesium scaffold demonstrated favorable performance, with low LLL and a low rate of clinical outcomes during the resorption period. These findings support DREAMS 3G as a promising “leave‐nothing‐behind” strategy for selected high‐risk plaques, warranting confirmation in larger prospective studies.