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Intravascular ultrasound predictors of long-term outcomes following ABSORB bioresorbable scaffold implantation: A pooled analysis of the ABSORB III and ABSORB Japan trials.

Intravascular ultrasound predictors of long-term outcomes following ABSORB bioresorbable scaffold implantation: A pooled analysis of the ABSORB III and ABSORB Japan trials.

Authors :
Nishi T
Okada K
Kitahara H
Kameda R
Ikutomi M
Imura S
Hollak MB
Yock PG
Popma JJ
Kusano H
Cheong WF
Sudhir K
Fitzgerald PJ
Ellis SG
Kereiakes DJ
Stone GW
Honda Y
Kimura T
Source :
Journal of cardiology [J Cardiol] 2021 Sep; Vol. 78 (3), pp. 224-229. Date of Electronic Publication: 2021 Apr 21.
Publication Year :
2021

Abstract

Background: The long-term prognostic impact of IVUS findings following Absorb BVS implantation remains uncertain. This study aimed to identify the IVUS predictors of long-term clinical outcomes following ABSORB bioresorbable vascular scaffold (BVS) implantation from the pooled IVUS substudy cohorts of the ABSORB III and Japan trials.<br />Methods: A total of 298 lesions in 286 patients were enrolled with 2:1 randomization to ABSORB BVS vs. cobalt-chromium everolimus-eluting stents. This sub-analysis included 168 lesions of 160 patients in the Absorb arm whose post-procedural quantitative IVUS were available. The primary endpoint of this analysis was device-oriented composite endpoint (DOCE) of target lesion failure, including cardiac death, target vessel-related myocardial infarction, or ischemia-driven target lesion revascularization. The median follow-up duration was 4.9 [3.1-5.0] years.<br />Results: During follow-up, DOCE occurred in 10.1% of lesions treated with Absorb BVS. Among several post-procedural IVUS indices associated with DOCE, non-uniform device expansion (defined as uniformity index = minimum / maximum device area) (hazard ratio 0.47 per 0.1 increase [95%CI 0.28 to 0.77]; p = 0.003) and residual reference plaque burden (hazard ratio 4.01 per 10% increase [95%CI 1.50 to 10.77]; p = 0.006) were identified as independent predictors of DOCE by Cox multivariable analysis.<br />Conclusions: Nonuniform device expansion and substantial untreated residual plaque in reference segments were associated with long-term adverse events following BVS implantation. Baseline imaging to identify the appropriate device landing zone and procedural imaging to achieve uniform device expansion if possible (e.g. through post-dilatation) may improve clinical outcomes of BVS implantation.<br />Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01751906 (ABSORB III); NCT01844284 (ABSORB Japan).<br /> (Copyright © 2021. Published by Elsevier Ltd.)

Details

Language :
English
ISSN :
1876-4738
Volume :
78
Issue :
3
Database :
MEDLINE
Journal :
Journal of cardiology
Publication Type :
Academic Journal
Accession number :
33893022
Full Text :
https://doi.org/10.1016/j.jjcc.2021.03.005