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Cordero et al. Bioresorbable scaffolds in acute coronary syndrome

and preventing coronary wall recoil and constrictive mortality risk was assessed by the Global Registry of
remodelling. Percutaneous coronary intervention Acute Coronary Events (GRACE) score; according to
[6]
(PCI) with stents was progressively adopted as the individual scores patients with categorised in low risk
standard of care for interdiction of ACS, myocardial < 108), intermediate risk (109-130) and high-risk (>
[3]
ischemia and infarction. However, as this strategy 140). All patients with STEMI received primary PCI
[7]
was being adopted it became clear that stent restenosis and patients with non-STEMI were referred for PCI,
was a frequent and potentially fatal complication in if appropriate as determined by a comprehensive
patients treated with BMS. Drug-eluting stents (DES) medical evaluation. According to previous reports,
[6]
largely overcame the restenosis problem with BMS but incomplete coronary revascularisation was defined as
they were also linked to many long-term complications when at least one of the main coronary arteries, or a
such as late stent-thrombosis, neo-atherosclerosis, secondary branch > 1.5 mm, with significant lesions
side-branch jailing and/or preclusion of future surgical (> 70%), was treated but not fully revascularised. [17,18]
revascularisation at the same lesion. [8]
Risk factors, clinical antecedents, treatments,
Bioresorbable vascular scaffolds (BVS) are newly complementary tests, and main diagnosis at discharge
adopted device for coronary stenting and were were tabulated for all subjects by trained medical
[5]
designed to minimise the long-term complications of staff. For the diagnosis of previous coronary artery
stents by providing an on-permanent scaffold. The disease, subjects needed to have a clinical diagnosis
[9]
[6]
first BVS was designed and tested in humans at the of myocardial infarction, stable or unstable angina or
end of last century and now shows promising results known prior coronary revascularisation. Previous heart
in terms of feasibility and complete reabsorption. [10] failure was determined based upon their prior clinical
Several randomised clinical trials and meta-analyses diagnosis of heart failure. Glomerular filtration rate
have outlined the usefulness of BVS for coronary was estimated from serum creatinine values with the
revascularisation, [11-13] although the clinical benefit for Modification of Diet in Renal Disease Study equation.
ACS patients has not been well analysed. [14,15] The Overall estimation of comorbidities was assessed by
objective of our study was to report the safety and the Charlson Index, adapted for patients with coronary
utility of BVS compared to other stents in a cohort of heart disease; [19] patients with a Charlson score ≥ 4 were
ACS patients. considered as having high-comorbidity risks. Following
current recommendations, optimal medical treatment
METHODS was codified when patients received prescriptions
for four medical treatments: an antiplatelet agent, a
Study design statin, a beta-adrenergic blocker, and an angiotensin-
In 2009, we initiated an ongoing prospective registry of converter enzyme inhibitor or angiotensin-receptor
all patients admitted for ACS in our institution. Several blocker. [20,21] Statin treatment was classified as low
results have already been published. [5,16] For this study, intensity, moderate intensity, or high intensity based
we included all patients admitted with the diagnosis of on the current guidelines. [22,23] Ticagrelor and prasugrel
ACS between January 2013 and March 2016, resulting were analysed together as a group of new antiplatelet
in a cohort of 951 consecutive subjects. The patients agents in place of clopidogrel.
were classified according to the stent type that was
used and the cohort was divided in 4 groups: no stent, The post-discharge follow-up of all subjects followed
BMS, DES, or BVS. The interventional cardiologist a well-established protocol. The end-points analysed
made the treatment decisions and stent selection after were cardiovascular and all-cause mortality as well as
considering the clinical situation. The DES implanted time to first major cardiovascular event (MACE) (ACS,
during the study period were all second- and third- heart failure hospitalisation, fatal or non-fatal stroke, or
generation devices. Intravascular ultrasound and major bleeding). Two staff members reviewed clinical
optical coherence tomography were performed in records, and (in absence of hospital contact), the
most cases where a BVS was implanted but the electronic medical history was consulted for outpatient
final decisions were made according to the treating follow-up care. All physicians in the geographic area
physicians’ clinical judgements. use a unified electronic medical record (EMR) that
documents every contact with the health care system,
ACS was defined by the presence of typical clinical for either medical or nursing visits. If electronic medical
symptoms of unstable angina or impending myocardial reports were lacking, one nurse who had been trained
infarction. ACS was classified as ST-elevation to acquire the needed data by telephone was directed
myocardial infarction (STEMI) and non-STEMI to call the subject and assess all endpoints through
according to the electrocardiographic findings. The a follow-up conversation. All emergency calls, visits

Vessel Plus ¦ Volume 1 ¦ June 27, 2017 69