Clin Res Cardiol 107, Suppl 1, April 2018

Everolimus eluting bioresorbable vascular scaffolds in patients with acute coronary syndromes: 2 year results from the German-Austrian ABSORB Registry (GABI-R)

M. Tröbs1, S. Achenbach1, C. Schlundt1, H. Nef2, J. Wiebe3, J. Kastner4, J. Mehilli5, T. Münzel6, C. K. Naber7, T. Neumann8, G. Richardt9, A. Schmermund10, J. Wöhrle11, R. Zahn12, T. Riemer13, C. W. Hamm2, für die Studiengruppe: GABI-R

1Med. Klinik 2 - Kardiologie, Angiologie, Universitätsklinikum Erlangen, Erlangen; 2Medizinische Klinik I - Kardiologie und Angiologie, Universitätsklinikum Gießen und Marburg GmbH, Gießen; 3Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, München; 4Innere Medizin II, Klinische Abteilung für Kardiologie, Allgemeines Krankenhaus der Stadt Wien - Medizinischer Universitätscampus, Wien, AT; 5Medizinische Klinik und Poliklinik I, LMU Klinikum der Universität München, München; 6Med. Klinik und Poliklinik II, Klinik für Kardiologie, Angiologie und intern. Intensivmedizin, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz; 7Klinik für Kardiologie und Angiologie, Elisabeth-Krankenhaus Essen, Essen; 8Klinik für Kardiologie, Universitätsklinikum Essen, Essen; 9Herzzentrum, Segeberger Kliniken GmbH, Bad Segeberg; 10Medizinisches Versorgungszentrum, CCB am AGAPLESION BETHANIEN KRANKENHAUS, Frankfurt am Main; 11Klinik für Innere Med. II, Universitätsklinikum Ulm, Ulm; 12Medizinische Klinik B - Abteilung für Kardiologie, Klinikum der Stadt Ludwigshafen gGmbH, Ludwigshafen am Rhein; 13Haus M, Stiftung Institut für Herzinfarktforschung, Ludwigshafen am Rhein;

Background: The use of bioresorbable vascular scaffolds (BVS) for coronary revascularization in patients with acute coronary syndromes (ACS) is controversial. Increased thrombogenicity and difficulties in determining vessel dimensions for appropriate sizing leading to a potentially higher downstream rate of adverse events are theoretical concerns as compared to BVS use in stable coronary artery disease (CAD). We therefore compared 2-year outcomes after coronary revascularization with BVS in a cohort of consecutive all-comer between patients with ACS and stable CAD. Methods: GABI-R is a prospective multi-center observational study of 3326 consecutive patients who underwent coronary revascularization with implantation of at least one BVS between 11/2013 und 01/2016 and were systematically followed for major adverse cardiac events (MACE, a composite of death, target vessel revascularization, and myocardial infarction), target lesion failure (TLF, a composite endpoint of cardiac death, target vessel myocardial infarction and target lesion revascularization) as well as scaffold thrombosis. Results: At the time point of analysis, 2-year follow-up data were available for 2465 patients. A total of 1262 patients presented with an ACS (51% of all patients). STEMI was present in 32.7% of all ACS patients, NSTEMI in 43.9%, and unstable angina in 23.5%. These patients were compared to 1203 patients with stable CAD. At least one BVS was successfully implanted in 98.1% of all cases with ACS and 98.1% of all cases with stable CAS. Patients with ACS were significantly younger (ACS: 60±11 vs. stable CAD: 63±11 years, p < 0.001) and less frequently had diabetes (18% vs. 23%, p < 0.001), hyperlipidemia (50% vs. 66%, p < 0.001), or hypertension (67% vs. 81%, p < 0.001). Current smoking was more prevalent in ACS (41% vs. 26%, p < 0.001). Single vessel disease was more prevalent in ACS patients (46% vs. 37%, p<0.001). There was no difference regarding lesion complexity (B2/C stenosis 37.1% vs. 36.9%%, bifurcation lesions 2.6% vs. 3.7%), number of implanted scaffolds/patient (1.5 vs. 1.6), mean scaffold diameter (3.1±0.5 vs. 3.1±0.7mm), scaffold length (19.5±6.1 vs. 19.8±6.3 mm) or the rate of high pressure post-dilatation (68% vs. 71%). MACE rates after 2 years were 10.5% in patients with ACS and 11.5% in patients with stable CAD (n.s.). TLF occurred in 6.4% vs. 7.1% (n.s.) and target vessel revascularization in 8.2% of patients with ACS vs. 10.4% of patients with stable CAD (n.s.). Definite scaffold thrombosis rates were not significantly different (ACS 1.8% vs. stable CAD 2.2%). Conclusion: Real-world 2-year event rates after coronary revascularization with BVS are higher than in controlled trials, but not significantly different between individuals with acute coronary syndromes as compared to stable coronary artery disease.

http://www.abstractserver.de/dgk2018/jt/abstracts//V543.htm