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Cordero et al. Bioresorbable scaffolds in acute coronary syndrome

All-cause mortality MACEs/100 patients/year
1.00
No stent 42.9
0.90
BMS 32.3
0.80
DES 24.4
Log-rank test P < 0.01
0.70
0 1 2 3 BVS 12.4
Number at risk Follow-up (years)
Stent type = None 145 98 27 6 0 5 10 15 20 25 30 35 40 45
Stent type = BMS 157 123 31 10
Stent type = DES 505 323 119 37 Figure 2: Major cardiovascular event (MACE) rates/100 patients/
Stent type = BVS 50 35 6 1
year according to stent type. BMS: bare metal stent; DES: drug-
None BMS DES BVS eluting stent; BVS: bioresorbable vascular scaffold
Cardiovascular mortality
1.00 recorded in patients that received no stents, followed
by BMS, DES, and BVS [Figure 2]. Multivariate analysis
did not find any associations of mortality or cumulative
0.90
MACEs with stent type [Table 4]. Diabetes, age > 75
years and GRACE score > 140 were associated with
0.80
higher cardiovascular and all-cause mortality, whereas
Log-rank test P < 0.01 predictors of recurrent MACEs included age > 75
0.70 years, diabetes, and previous cardiovascular disease;
0 1 2 3
Number at risk Follow-up (years) revascularisation was negatively associated with
Stent type = None 145 98 27 6 recurrent events.
Stent type = BMS 157 123 31 10
Stent type = DES 505 323 119 37
Stent type = BVS 50 35 6 1 DISCUSSION
None BMS DES BVS
This single-centre experience with BVS supports
First MACE their safety and effectiveness for revascularisation
1.00 during ACS. BVS-treated patients had a lower risk
profile despite the fact that they had more coronary
0.80 lesions and were treated more aggressively, as they
received a higher number of stents, more complete
0.60 revascularisation, and more intensive antiplatelet and
statin regimens.
Log-rank test P = 0.16
0.40
0 1 2 3 Decision-making for stent use is influenced by many
Number at risk Follow-up (years) factors related to patient characteristics, coronary
Stent type = None 137 80 22 5 lesions, and other risks. DES were introduced to better
Stent type = BMS 143 94 25 9
Stent type = DES 486 273 90 21 control the rate of restenosis that occurs in patients
Stent type = BVS 49 31 5 1 treated with BMS. The superiority of DES has been
None BMS DES BVS largely demonstrated, [25] although mortality benefit was
only clearly outlined with the later generation of DES. [8]
Figure 1: Kaplan-Myer curves presenting cardiovascular mortality,
all-cause mortality and time to first major cardiovascular event BVS were conceived to avoid long-term complications
(MACE) according to stent type. BMS: bare metal stent; DES: drug- of the metal structures by providing temporary
eluting stent; BVS: bioresorbable vascular scaffold
structural integrity before being resorbed completely
within the vessel wall. [9,26] The long-term incidence of
BMS (9.5%), DES (4.0%), and BVS (3.7%) (log-rank cardiovascular events related to DES-treated vessels
test, P < 0.01). No differences were observed between is around 2% to 3% per year for at least 5 years [27,28]
DES and BVS in mortality rates. No differences were and the contribution of permanent metallic devices in
observed in the incidence of MACE according to stent lumen target lesions has a relevant contribution. [29]
type, although a tendency to lower incidence of time to The Absorb BVS is a 150 μm thick bioresorbable
®
first MACE was noted for BVS: no stent (28.8%), BMS polyl-lactide scaffold with a conformal bioresorbable
(31.5%), DES (25.5%), and BVS (16.7%) (P = 0.16). coating (with a total thickness of 7 μm) that elutes
The highest rate of MACEs/year/100 patients was everolimus. [30] Angiographic follow-up of BVS has

72 Vessel Plus ¦ Volume 1 ¦ June 27, 2017