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Background: Bioresorbable scaffolds (BRS) are a novel technology in coronary intervention. However, recent trials demonstrate higher rates of device failure compared to contemporary drug-eluting stents. This study sought to utilise a clinical quality registry to assess the medium-term safety of the Abbott Absorb BRS (Abbott Vascular, Santa Clara, CA, USA), in an Australian context. Method(s): A prospective, observational study of 192 BRS percutaneous coronary interventions (PCI) compared to 31,773 non-BRS PCIs entered in the Victorian Cardiac Outcomes Registry from 2013 to 2017. The main outcome measure was patient-oriented composite endpoint (POCE) events comprising all-cause mortality, any myocardial infarction (MI), and any revascularisation. Result(s): Bioresorbable scaffolds patients (mean age 61.6+/-10.5 years, 79% male) were younger, had less comorbidity, less prior PCI, fewer ST elevation myocardial infarction (STEMI) presentations, lower rates of multi-lesion disease and more adjuvant devices compared to non-BRS PCI (all p<0.01). All-cause mortality was 2.1%, myocardial infarction (MI) 2.1%, scaffold thrombosis 3.1% and any revascularisation 14.1% (mean follow-up 27.4+/-8.9 months). POCE events occurred in 11.5% at 1 year and 16.9% at 2 years, comparable to pooled-trial data. Multivariate predictors of POCE were >1 scaffold used (odds ratio [OR] 4.6, 95% confidence interval [CI] 1.9-11.4, p<0.01) and scaffold diameter <=2.5 mm (OR 3.3, 95% CI 1.4-7.6, p=0.02). Over 95% guideline adherence was achieved in six of eight patient selection criteria and four of six device deployment criteria. Conclusion(s): In an Australian setting, BRS were used in non-complex patients. Most guidelines for use were adhered to and outcomes were comparable to pooled trial data. Clinical quality registries are effective in assessing novel treatments and technologies when potential safety concerns develop.Copyright © 2019 Australian and New Zealand Society of Cardiac and Thoracic Su

Background: Rheumatoid arthritis (RA) is the most common inflammatory arthritis and is associated with increased risk of cardiovascular events and mortality. Data regarding long-term percutaneous coronary intervention (PCI) outcomes are limited. Method(s): The Melbourne Interventional Group PCI registry (2005-2018) was used to identify 756 patients with RA and outcomes were compared to the remaining cohort (N=38,579). Cox regression analysis was performed to assess risk of adverse events. Result(s): Patients with RA were older and more often female, with higher rates of hypertension, previous stroke, peripheral vascular disease, obstructive sleep apnoea, chronic lung disease, prior myocardial infarction, and poor renal function, while rates of current smoking were lower, all p<0.05. Lesions were more frequently complex (ACC/AHA type B2/C), required longer stents, and rates of no reflow were higher, all p<0.05. Mortality at 30-days was higher (4.4% vs 3.3%, p=0.04) mainly relating to higher non-cardiac mortality (1.6% vs 0.8%, p=0.01). Risk of long-term mortality was higher for RA patients (28% vs 19%, mean follow-up 5.4 years, Hazard Ratio [HR] 1.44, 95% CI 1.25-1.67 adjusted for age, sex and comorbidities) and varied by PCI indication subtype (STEMI HR 1.38, 95% CI 1.06-1.81; NSTEACS HR 1.86, 95% CI 1.49-2.34; non-ACS HR 1.09, 95% CI 0.75-1.59). Risk of 30-day mortality, MACE, bleeding, and target lesion revascularisation were similar. Conclusion(s): Patients with RA undergoing PCI have more comorbidities and longer, more complex coronary lesions. Risk of short-term adverse outcomes are similar, while risk of long-term mortality is higher, especially among patients with acute coronary syndromes.Copyright © 2020