Optimizing vessel sizing and operator technique during first-generation bioresorbable vascular scaffold (BVS) implantation may improve 3-year outcomes in patients undergoing treatment for coronary lesions, according to a large-scale analysis of the major ABSORB studies presented at Transcatheter Cardiovascular Therapeutics 2017, held October 29 to November 2, 2017, in Denver, Colorado.1 Results of the analysis were simultaneously published in the Journal of the American College of Cardiology.2
In this study, investigators pooled data from 5 different prospective trials (ABSORB II, ABSORB III, ABSORB China, ABSORB Japan, and ABSORB Extend). They sought to determine whether operator technique had an effect on target lesion failure (TLF) and scaffold thrombosis (ScT) at 3 years in patients with coronary artery lesions treated with BVS (n=2973).
Across studies, vessel size selection (81.6% of patients), optimal predilation (59.2% of patients), and postdilation (12.4% of patients) were performed for lesions treated with BVS. The investigators found BVS implantation was an independent predictor for TLF freedom at 1 year (hazard ratio [HR], 0.67; P =.01) and 3 years (HR, 0.72; P =.01) when performed in properly sized vessels.
In addition, implantation of BVS in properly sized vessels provided a significant independent predictor for ScT freedom through 1 year (HR, 0.36; P =.004) and TLF freedom at 3 years (HR, 0.72; P =.01). The use of aggressive predilation was also shown to be an independent predictor of ScT freedom between 1 and 3 years (HR, 0.44; P =.03), whereas optimization of postdilation technique was an independent predictor for TLF freedom between 1 and 3 years (HR, 0.55; P =.05).
Because this study investigated operator technique only as it relates to predilation and postdilation as well as vessel and device sizing, the investigators suggested future studies are necessary to determine other lesion- and/or procedure-related characteristics that might affect post-BVS-implantation outcomes.
The investigators of this pooled data analysis also noted that the ABSORB IV randomized clinical trial is currently underway to address “whether greater attention to technique may narrow the early clinical differences between BVS and metallic drug-eluting stents” in this patient population.
- Stone GW, Abizaid A, Onuma Y, et al. Effect of technique on outcomes following bioresorbable vascular scaffold Implantation: analysis from the ABSORB trials. Presented at: TCT 2017 Meeting. October 29-November 2, 2017; Denver, CO.
- Stone GW, Abizaid A, Onuma Y, et al. Effect of technique on outcomes following bioresorbable vascular scaffold implantation: analysis from the ABSORB trials [published online October 31, 2017]. J Am Coll Cardiol. doi:10.1016/j.jacc.2017.09.1106