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Overlapping scaffolds associated with increased periprocedural MI
Overlapping of bioresorbable vascular scaffolds was linked to increased rates of periprocedural MI but no immediate or long-term effects on cardiac death, target lesion revascularization or stent thrombosis, according to the results of the ABSORB EXTEND trial.
“In theory, the recent introduction of BVS has made [overlapping] more attractive, since these devices will be ultimately absorbed and the functionality of the treated segment should be potentially restored,” J. Ribamar Costa Jr., MD, from the department of interventional cardiology at the Instituto de Cardiologia Dante Pazzanese in Sao Paulo, and colleagues wrote. “Nonetheless, it is important to keep in mind that the current generation of BVS is still bulky with strut thickness and width of about 150 and 200 m, respectively, which are higher than those of the first-generation DES and may affect acute and long-term outcomes of this novel technology.”
To draw a comparison between acute and 2-year outcomes of patients treated with and without overlapping scaffolds (Absorb, Abbott Vascular), Costa and colleagues conducted an analysis of all 812 patients with 874 lesions enrolled in the prospective, single-arm, open-label ABSORB EXTEND study. The primary objective was to compare MACE and scaffold thrombosis rates up to 2 years.
The two cohorts showed comparable baseline clinical and angiographic characteristics with the exception of longer lesions in the overlapping patients (16.7±7.3 mm vs. 11.6±4.4 mm; P<.0001), higher lesion complexity (B2 category, 66% vs. 38%; P < .01) and numerically smaller vessel size.
The results showed a higher rate of in-hospital MACE in the overlapping cohort (7% vs. 0.9%; P=.002), exclusively driven by a higher rate of periprocedural MI (7% vs. 0.9%, P=.002).
There was no significant difference in long-term MACE between the groups (10.4% in the overlapping cohort vs. 6.6% in the no-overlapping group), and there were similar rates of cardiac death (0.9% vs. 1.2%) and ischemia-driven TLR (1.7% vs. 2.5%).
Cumulative incidence of MI was higher in the overlapping cohort (7.8% vs. 3%, P=.02), Costa and colleagues found.
The researchers found a lower rate of MI between hospital discharge and 2 years in the overlapping cohort (0.8% vs. 2.1%; P=.04).
The analysis showed relatively low incidence of definite/probable scaffold thrombosis in both groups (overlapping group, 1.8%; no-overlapping group, 1.5%; P = .7).
According to the researchers, there are several limitations to keep in mind when considering the results of the study.
“To the best of our knowledge, this is the largest long-term follow-up of patients undergoing treatment with [overlapping] scaffolds,” they wrote. “The results of this study should be interpreted with caution due to the differences in baseline lesion characteristics between the two groups.”
Also, they wrote, the study was underpowered for low-frequency events such as stent thrombosis, the implantation technique used is now considered outdated and the patients were not compared with those implanted with a metallic drug-eluting stent. – by Dave Quaile
Disclosures: The authors report no relevant financial disclosures.