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Contemporary studies have established encouraging clinical outcomes for the everolimus-eluting bioresorbable vascular scaffold (BVS) ABSORB™ in patients with stable coronary artery disease (CAD). There is limited data on its use in patients presenting with acute coronary syndromes (ACS). We aimed to evaluate the safety and efficacy of BVS deployment in the setting of ACS at our tertiary cardiac center in southwestern Ontario.
Retrospective chart review of all ACS with BVS use was undertaken since June 2013. Data was analyzed for baseline demography and in-hospital and 30-day mortality.
43 BVS were deployed in 30 patients. Mean age was 56.5+2.2 years; 30% were female and 76.6% were less than 65 years old. Nearly 70% were hypertensive and dyslipidemic, while one-third were diabetics and smokers. 50% of the patients presented with STEMI, of which 86.7% received primary PCI. Mean total Syntax score was 14.0+1.5 and 72.1% of lesions were ACC Type “B” lesions, with visible thrombus present in one-third. Complete occlusion was seen in 18.6% of lesions at the outset. 62.8% were LAD lesions. All BVS were deployed in the first attempt. 75% (33/43) of BVS were post dilated. Final TIMI-3 flow was evident in 42 (97.7%) patients, with no case of worsening coronary flow. 30% of all BVS were deployed across bifurcations without any loss of coronary flow in the side branches. There has been no reported case of in-hospital or 30-day mortality, early stent thrombosis or repeat revascularization of the index artery.
Our experience suggests that usage of BVS, in selected 'real-world' patients with ACS, may be a safe and practical option with favorable short-term outcomes. Long-term follow up data and further evaluation in larger randomized controlled trials is needed.