Early and midterm outcomes of bioresorbable vascular scaffolds for ostial coronary lesions: insights from the GHOST-EU registry.
OBJECTIVE
We aimed to investigate the outcomes of bioresorbable vascular scaffolds (BVS) in coronary ostial lesions. Ostial lesions represent a challenging angiographic subset, with higher event rates compared with non-ostial lesions. BVS might be associated with advantages over the long term, but their safety in this setting remains to be explored.


RESULTS
Procedural and 12-month follow-up data from consecutive patients treated with BVS for lesions located at the ostium of the right (RCA), left anterior (LAD) or circumflex (LCX) coronary in 11 European centres were collected. The primary device-oriented endpoint was defined as a combination of cardiovascular death, target vessel myocardial infarction or target lesion revascularisation. The database included a total of 1,549 lesions in 1,304 patients with a mean age of 62±11years. There were 90 ostial lesions (5.8%) in 84 patients (6.4%) located at the ostial RCA (14; 16%), LCX (29; 32%), or LAD (47; 52%). Patients presenting with ostial lesions did not differ from the remaining cohort except for a higher incidence of prior revascularisation. Predilation was performed in 97% of the lesions (vs. 96% in non-ostial, p=0.618), post-dilation in 43% (versus 58% in the non-ostial group, p=0.008). At quantitative coronary angiography, treatment of ostial lesions was associated with higher residual stenosis (30% [23-41] vs. 26% [20-37], p=0.035), but no difference in minimum lumen diameter existed (p=0.447). Follow-up data were available at 385 [362-465] days. The 12-month Kaplan-Meier estimated rates of scaffold thrombosis were 4.9% and 2.0% (ostial and non-ostial lesion groups, respectively, log-rank p=0.005). The device-oriented composite endpoint occurred, respectively, in 12.6% and 4.6% at 12 months (log-rank p=0.001). Treatment of ostial lesions was an independent predictor of this endpoint (p=0.0025, HR 2.65 [1.41-4.97]).


CONCLUSIONS
In combination with a suboptimal implantation technique, treatment of coronary ostial lesions was an independent predictor of clinical events in a cohort of patients treated with BVS.
2. Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz, University Medical Center, Mainz and DZHK Rhein-Main, Germany.
Tommaso
T
Gori
Jens
J
Wiebe
Davide
D
Capodanno
Azeem
A
Latib
Maciej
M
Lesiak
Stylianos A
SA
Pyxaras
Julinda
J
Mehilli
Giuseppe
G
Caramanno
Carlo
C
Di Mario
Salvatore
S
Brugaletta
Julia
J
Weber
Piera
P
Capranzano
Manel
M
Sabate
Alessio
A
Mattesini
Salvatore
S
Geraci
Christoph K
CK
Naber
Aleksander
A
Araszkiewicz
Antonio
A
Colombo
Corrado
C
Tamburino
Holger
H
Nef
Thomas
T
Münzel
D020341:Absorbable Implants; D000328:Adult; D000368:Aged; D003324:Coronary Artery Disease / Q000628:therapy; D003331:Coronary Vessels / Q000601:surgery*; D054855:Drug-Eluting Stents / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000379:methods; D012042:Registries; D054457:Tissue Scaffolds / Q000009:adverse effects; D016896:Treatment Outcome