Author + information
- Simone Biscaglia, MD∗ ( and )
- Gianluca Campo, MD
- ↵∗Cardiovascular Institute, Medical Sciences Department, Azienda Ospedaliero-Universitaria S. Anna, Via Aldo Moro 8, 44124 Cona, Ferrara, Italy
We read with great interest the manuscript by Geraci et al. (1), reporting a subanalysis of the GHOST-EU (Gauging coronary Healing with bioresorbable Scaffolding plaTforms in EUrope) registry on long coronary lesions treated with bioresorbable vascular scaffolds (BVS). The authors conclude that treatment of very long coronary lesions with BVS (≥60 mm) was associated with a higher target lesion failure rate if compared to treatment with shorter length of BVS (either ≤30 mm or 30 to 60 mm).
However, the message of the study could be misleading. First, it is difficult to draw any conclusion on clinical hard endpoints taking into account a subgroup of 81 patients. Second, the differences in target lesion failure rate among groups (≥60 mm vs. others) can be explained by unbalanced baseline and procedural characteristics between the 3 groups. Well-established confounding factors such as diabetes mellitus II, ostial lesions, and lesion length emerged have predictors of adverse events at the multivariate analysis and, obviously, were significantly more frequent in patients treated with ≥60 mm of BVS. Third, this finding is not new. A recent study showed that patients and lesions complexity impact on major adverse cardiac events (MACE) in patients treated with new-generation drug-eluting stents (DES) exactly in the same way (2). As correctly showed by authors in Table 6, the MACE rate in the ≥60-mm group is superimposable with one of the previous trials with DES. Thus, the difference in the outcome is attributable to patient and lesion complexity rather than to the use of a specific device.
A really important issue raised by authors is the unacceptably high rate of scaffold thrombosis (3.8% at 1 year) in the ≥60-mm group. Their worrisome results have been recently reinforced by presented and published data (3,4) confirming that BVS are more prone to device thrombosis than DES are. However, we have no information on how overlap was performed in the study and no standard implantation technique was implemented (namely aggressive pre-dilatation, sizing, post-dilatation). Previously published data have shown that with a systematic correct implantation technique imaging-guided, overlapping BVS could be comparable to second-generation DES (5).
In conclusion, we think that given the recent amount of worrisome results on BVS, it is of paramount importance to wait for a greater body of evidence coming from big populations with standardized procedures rather than to raise further question marks on small unmatched populations.
Please note: Both authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 2017 American College of Cardiology Foundation
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