Impact of calcium on procedural and clinical outcomes in lesions treated with bioresorbable vascular scaffolds - A prospective BRS registry study. (15th December 2017)

• Record Type: Journal Article
• Authors: Fam, Jiang Ming; Felix, Cordula; Ishibashi, Yuki; Onuma, Yoshinobu; Diletti, Roberto; Van Mieghem, Nicolas M.; Regar, Evelyn; De Jaegere, Peter; Zijlstra, Felix; van Geuns, Robert Jan M.
• Is Part Of: International journal of cardiology. Volume 249(2017)
• Page Start: 119
• Page End: 126
• Publication Date: 2017-12-15
• Subjects: BRS bioresorbable vascular scaffolds -- Ca calcium -- DOCE device oriented composite endpoints -- MACE major adverse cardiovascular events -- MI myocardial infarct -- MLD minimal lumen diameter -- PCI percutaneous coronary intervention -- POCE patient oriented composite endpoints -- QCA Quantitative Coronary Analysis -- RVD reference vessel diameter -- ST scaffold thrombosis -- TLR target lesion revascularization -- TVR target vessel revascularization; Bioresorbable vascular scaffolds -- Calcified lesions -- Scaffold thrombosis; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2017.08.046
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: There is limited data on the impact of calcium (Ca) on acute procedural and clinical outcomes in patients with lesions treated with bioresorbable vascular scaffolds (BRS). We sought to evaluate the effect of calcium on procedural and clinical outcomes in a 'real world' population. Methods: Clinical outcomes were compared between patients with at least 1 moderately or heavily calcified lesion (Ca) and patients with no/mild calcified lesions (non-Ca) enrolled in our institutional BRS registry. Results: 455 patients (N) with 548 lesions (L) treated with 735 BRS were studied. Patients in the Ca group (N = 160, L = 200) had more complex (AHA B2/C lesion: 69.0% in Ca vs 14.9% in non-Ca, p < 0.001) and significantly longer lesions (27.80 ± 15.27 vs 19.48 ± 9.92 mm, p < 0.001). Overall device success rate was 99.1% with no significant differences between the groups. Despite more aggressive lesion preparation and postdilation compared to non Ca, acute lumen gain was significantly less in Ca lesions (1.50 ± 0.66 vs 1.62 ± 0.69 mm, p = 0.040) with lower final MLD (2.28 ± 0.41 vs 2.36 ± 0.43, p = 0.046). There were no significant differences in all-cause mortality, total definite scaffold thrombosis (ST), target lesion revascularization and myocardial infarction between the 2 groups. Late ST was more frequent in the Ca group compared to non Ca group (late ST: 2.1 vs 0%, p = 0.02). Conclusions: Clinical outcomes after BRS implantation in calcified and non-calcified lesions were similar. A remarkable difference in timing of thrombosis was observed, with an increased rate of late thrombosis in calcified lesions.