Department of Cardiology, University & Hospital Fribourg, Fribourg, Switzerland.
Department of Cardiology, Luzerner Kantonsspital, Luzern, Switzerland.
J Am Coll Cardiol. 2016 Mar 1;67(8):921-931. doi: 10.1016/j.jacc.2015.12.019.
Recent reports suggest an elevated incidence of bioresorbable vascular scaffold (BVS) thrombosis (scaffold thrombosis [ScT]).
This study investigated occurrence rates, clinical and angiographic characteristics, and possible mechanisms of ScT in all-comer patients undergoing BVS implantation at 2 German and 2 Swiss hospitals.
A total of 1,305 consecutive patients (mean age 64 years, 78% male) who received 1,870 BVS (mean 1.4 ± 0.8 BVS/patient) were enrolled. Clinical/procedural characteristics, mortality, and ScT data at 485 days (range 312 to 652 days) were examined.
ScT occurred in 42 patients. The incidence of probable and definite ScT was 1.8% at 30 days and 3.0% at 12 months, without differences among centers (p = 0.60). A total of 22 (52%) ScTs presented as ST-segment elevation myocardial infarction and 6 (17%) as sudden cardiac death. In multivariable analysis, ostial lesions (p = 0.049) and impaired left ventricular ejection fraction (p = 0.019) were independently associated with ScT. Nine (21%) of the ScTs occurred in patients who had suspended dual antiplatelet therapy, in 6 cases prematurely. Lower post-procedural minimum lumen and reference vessel diameters were hallmarks of ScT (all p < 0.0001). The risk of ScT appeared to rapidly increase for post-procedural minimum lumen diameters below 2.4 mm (for the 2.5- to 3.0-mm BVS) and 2.8 mm (for the 3.5-mm BVS). When a BVS-specific implantation strategy was implemented, 12-month ScT rates fell from 3.3% to 1.0%, an effect that remained significant when adjusted for multivariable propensity score (p = 0.012; hazard ratio: 0.19; 95% confidence interval: 0.05 to 0.70).
The 12-month incidence of ScT reached 3% and could be significantly reduced when an optimized implantation strategy was employed. (retrospective multicentric registry and Mainz Intracoronary Database. The Coronary Slow-flow and Microvascular Diseases Registry [MICAT]; NCT02180178).
最近的报告表明，生物可吸收血管支架（BVS）血栓形成（支架血栓形成[ScT]）的发生率升高。
本研究旨在调查德国和瑞士的 2 家医院共收治的所有患者中 BVS 植入术后 ScT 的发生率、临床和血管造影特征以及可能的发病机制。
共纳入 1305 例连续患者（平均年龄 64 岁，78%为男性），共植入 1870 枚 BVS（平均每名患者植入 1.4±0.8 枚 BVS）。在 485 天（312 至 652 天）时评估临床/手术特征、死亡率和 ScT 数据。
42 例患者发生 ScT。30 天时可能和确定的 ScT 发生率为 1.8%，12 个月时为 3.0%，各中心之间无差异（p=0.60）。22 例（52%）ScT 表现为 ST 段抬高型心肌梗死，6 例（17%）为心脏性猝死。多变量分析显示，开口病变（p=0.049）和左心室射血分数受损（p=0.019）与 ScT 独立相关。9 例（21%）ScT 发生在中断双联抗血小板治疗的患者中，其中 6 例过早中断。支架内最小管腔直径和参考血管直径减小是 ScT 的标志（均 p＜0.0001）。支架内最小管腔直径低于 2.4mm（2.5-3.0mm BVS）和 2.8mm（3.5mm BVS）时，ScT 的风险似乎迅速增加。当采用特定于 BVS 的植入策略时，12 个月时 ScT 发生率从 3.3%降至 1.0%，经多变量倾向评分调整后仍有显著差异（p=0.012；危险比：0.19；95%置信区间：0.05 至 0.70）。
采用优化的植入策略时，12 个月时 ScT 的发生率可显著降低至 3%。（回顾性多中心登记和 Mainz 冠状动脉内数据库。冠状动脉慢血流和微血管疾病登记[MICAT]；NCT02180178）。
