Key result
Intravascular imaging guidance during Absorb bioresorbable vascular scaffold implantation was independently associated with a significant reduction in long-term major adverse cardiac events (HR 0.13).
Why the study?
Predictors of long-term adverse clinical events after implantation of the everolimus-eluting Absorb bioresorbable vascular scaffold had not been clearly established.
What are the predictors of long-term adverse clinical events after implantation of the everolimus-eluting Absorb bioresorbable vascular scaffold?
Cohort (n=1,933)
Yes
What are the predictors of long-term adverse clinical events after implantation of the everolimus-eluting Absorb bioresorbable vascular scaffold?
Hazard Ratio: 0.13 (95% CI 0.06–0.28)
Absolute Event Rate: 2.4% vs 5.8%
p-value: p=<0.001
Optimal implantation techniques and intravascular imaging guidance are strongly associated with reduced long-term adverse events following Absorb bioresorbable vascular scaffold implantation.
Optimal BVS technique with imaging may lower events in registries; leaves open need for randomized confirmation before practice change.
AIMS: The aim of this study was to investigate the predictors of long-term adverse clinical events after implantation of the everolimus-eluting Absorb bioresorbable vascular scaffold (BVS). METHODS AND RESULTS: We pooled patient-level databases derived from the large-scale ABSORB EXTEND study and five high-volume international centres. Between November 2011 and November 2015, 1,933 patients underwent PCI with a total of 2,372 Absorb BVS implanted. The median age was 61.0 (IQR 53.0 to 68.6) years, 24% had diabetes, and 68.2% presented with stable coronary artery disease. At a median follow-up of 616 days, MACE occurred in 93 (4.9%) patients, all-cause death in 36 (1.9%) patients, myocardial infarction in 47 (2.5%) patients, and target vessel revascularisation in 72 (3.8%) patients. Definite or probable scaffold thrombosis occurred in 26 (1.3%) patients. On multivariable logistic regression analysis, acute coronary syndromes (hazard ratio [HR] 2.79, 95% confidence interval [CI]: 1.47 to 5.29; p=0.002), dyslipidaemia (HR 1.43, 95% CI: 1.23 to 1.79; p=0.007), scaffold/reference diameter ratio >1.25 (HR 1.49, 95% CI: 1.18 to 1.88; p=0.001), and residual stenosis >15% (HR 1.67, 95% CI: 1.34 to 2.07; p<0.001) were independent predictors of MACE, whereas the use of intravascular imaging was independently associated with a reduction in MACE (HR 0.13, 95% CI: 0.06 to 0.28; p<0.001). CONCLUSIONS: Optimal Absorb BVS implantation and the use of intravascular imaging guidance are associated with lower rates of adverse events at long-term follow-up.
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Caixeta et al. (2019) conducted a cohort in Coronary artery disease (n=1,933). Intravascular imaging guidance vs. Angiographic guidance alone was evaluated on Major adverse cardiac events (MACE) (HR 0.13, 95% CI 0.06-0.28, p=<0.001). Intravascular imaging guidance during Absorb bioresorbable vascular scaffold implantation was independently associated with a significant reduction in long-term major adverse cardiac events (HR 0.13).
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