Best of JACC: Cardiovascular Interventions

OBJECTIVES The purpose of this study was to compare the 1-year outcome between bioresorbable vascular scaffold (BVS) and everolimus-eluting metallic stent (EES) in ST-segment elevation myocardial infarction (STEMI) patients. BACKGROUND The Absorb BVS (Abbott Vascular, Santa Clara, California) is a polymeric scaffold approved for treatment of stable coronary lesions. Limited and not randomized data are available on its use in ST-segment elevation myocardial infarction (STEMI) patients. METHODS This study included 290 consecutive STEMI patients treated by BVS, compared with either 290 STEMI patients treated with EES or 290 STEMI patients treated with bare-metal stents (BMS) from the EXAMINATION (A Clinical Evaluation of Everolimus Eluting Coronary Stents in the Treatment of Patients With ST-segment Elevation Myocardial Infarction) trial, by applying propensity score matching. The primary endpoint was a device-oriented endpoint (DOCE), including cardiac death, target vessel myocardial infarction, and target lesion revascularization, at 1-year follow-up. Device thrombosis, according to the Academic Research Consortium criteria, was also evaluated. RESULTS The cumulative incidence of DOCE did not differ between the BVS and EES or BMS groups either at 30 days (3.1% vs. 2.4%, hazard ratio [HR]: 1.31 [95% confidence interval (CI): 0.48 to 3.52], p 1⁄4 0.593; vs. 2.8%, HR: 1.15 [95% CI: 0.44 to 2.30], p 1⁄4 0.776, respectively) or at 1 year (4.1% vs. 4.1%, HR: 0.99 [95% CI: 0.23 to 4.32], p 1⁄4 0.994; vs. 5.9%, HR: 0.50 [95% CI: 0.13 to 1.88], p 1⁄4 0.306, respectively). Definite/probable BVS thrombosis rate was numerically higher either at 30 days (2.1% vs. 0.3%, p 1⁄4 0.059; vs. 1.0%, p 1⁄4 0.324, respectively) or at 1 year (2.4% vs. 1.4%, p 1⁄4 0.948; vs. 1.7%, p 1⁄4 0.825, respectively), as compared with EES or BMS. CONCLUSIONS At 1-year follow-up, STEMI patients treated with BVS showed similar rates of DOCE compared with STEMI patients treated with EES or BMS, although rate of scaffolds thrombosis, mostly clustered in the early phase, was not negligible. Larger studies with longer follow-up are needed to confirm our findings. (J Am Coll Cardiol Intv 2015;8:189–97) © 2015 by the American College of Cardiology Foundation. From the *Thorax Institute, Hospital Clinic, University of Barcelona, Institut d’Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; yMedizinische Klinik und Poliklinik für Kardiologie, Angiologie und innere Intensivmedizin, Mainz, Germany; zCardiac Department, National University Heart Centre Singapore, National University Health System, Singapore; xCardiocenter, J A C C : C A R D I O V A S C U L A R I N T E R V E N T I O N S V O L . 8 , N O . 1 , 2 0 1 5 a 2 0 1 5 B Y T H E AM E R I C A N C O L L E G E O F C A R D I O L O G Y F O U NDA T I O N I S S N 1 9 3 6 8 7 9 8 / $ 3 6 . 0 0 P U B L I S H E D B Y E L S E V I E R I N C . h t t p : / / d x . d o i . o r g / 1 0 . 1 0 1 6 / j . j c i n . 2 0 1 4 . 1 0 . 0 0 5