Author + information
- Received February 20, 2018
- Revision received April 10, 2018
- Accepted April 24, 2018
- Published online August 20, 2018.
- Josep Gomez-Lara, MD, PhDa,∗ (, )
- Salvatore Brugaletta, MD, PhDb,
- Luis Ortega-Paz, MDb,
- Bert Vandeloo, MDa,
- Elisabetta Moscarella, MDb,
- Miguel Salas, MDa,
- Rafael Romaguera, MDa,
- Gerard Roura, MDa,
- José L. Ferreiro, MD, PhDa,
- Luis Teruel, MDa,
- Montserrat Gracida, MDa,
- Stephan Windecker, MDc,
- Patrick W. Serruys, MD, PhDd,
- Joan-Antoni Gomez-Hospital, MD, PhDa,
- Manel Sabaté, MD, PhDb and
- Angel Cequier, MD, PhDa
- aDepartment of Interventional Cardiology, Institut d’Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, Universitat de Barcelona, L’Hospitalet de Llobregat, Spain
- bInstitut d’Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
- cDepartment of Cardiology, Bern University Hospital, Bern, Switzerland
- dInternational Centre for Circulatory Health, National Health and Lung Institute, Imperial College London, London, United Kingdom
- ↵∗Address for correspondence:
Dr. Josep Gomez-Lara, Department of Interventional Cardiology, Hospital Universitari de Bellvitge, c/Feixa Llarga sn, L’Hospitalet de Llobregat, Spain.
Objectives The study sought to compare the vasomotor and microcirculatory function of the infarct-related artery (IRA) between bioresorbable vascular scaffolds (BVS) and everolimus-eluting stents (EES) at 3 years.
Background The ABSORB STEMI TROFI II study showed similar outcomes between BVS and EES in the context of ST-segment elevation myocardial infarction at 3 years.
Methods Sixty-three consecutive event-free patients of the randomized TROFI II study were screened to undergo coronary angiography with vasomotor, microcirculatory, and optical coherence tomography (OCT) examination at 3 years. Vasomotion was defined as >4% change in mean lumen diameter to acetylcholine (ACH) and nitroglycerin as assessed by quantitative angiography. Microcirculatory examination was performed with pressure or thermodilution techniques.
Results A total of 38 patients (20 BVS and 18 EES) were included. At 3 years, ≥60% of patients exhibited paradoxical vasoconstriction to ACH in the periscaffold or stent segments. Vasoconstriction to ACH and vasodilatation to nitroglycerin were more often observed in the scaffold or stent segment with BVS than with EES (77.8% vs. 25.0%; p = 0.008 and 61.1% vs. 18.8%; p = 0.018). The IRA-depending microcirculation showed similar index of resistance (23.8 vs. 22.4; p = 0.781), coronary flow reserve (2.4 vs. 1.9; p = 0.523), fractional flow reserve (0.91 vs. 0.93; p = 0.317), and absolute flow (135.5 ml/min vs. 147.3 ml/min; p = 0.791). OCT showed remaining strut footprints and larger number of intraluminal scaffold dismantling (26.3% vs. 0%; p = 0.049) in the BVS group.
Conclusions Both endothelium-dependent and -independent vasomotion of the IRA were more evident with BVS, as compared with EES, at 3 years. Functional microcirculatory parameters were mostly adequate and similar between BVS and EES. Clinical implications of these findings warrant further investigations.
- bioresorbable vascular scaffolds
- drug-eluting stent(s)
- endothelial dysfunction
- optical coherence tomography
- ST-segment elevation myocardial infarction
The study has been funded by grants of the Catalan and Spanish Societies of Cardiology. Dr. Vandeloo has received a scholarship from the Frans De Werf Fund for Cardiovascular Research to conduit the present study. Dr. Windecker has received institutional research grants from Abbott, Amgen, Biotronik, Boston Scientific, and St. Jude Medical. Dr. Sabaté is a consultant for Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 20, 2018.
- Revision received April 10, 2018.
- Accepted April 24, 2018.
- 2018 American College of Cardiology Foundation
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