title: Impact of the learning curve on procedural results and acute outcome after percutaneous coronary interventions with everolimus-eluting bioresorbable scaffolds in an all-comers population.
abstract: OBJECTIVE
  The implantation of bioresorbable scaffolds (BVSs) is an emerging technique in the treatment of coronary lesions and implantation of BVSs is different than that of metallic drug-eluting stents, however, due to different mechanical properties. This investigation focused on procedural and mid-term results and was designed to evaluate whether there is evidence of a learning curve with BVSs and how it might influence the clinical outcome.
  
  
  METHODS
  In an all-comers registry, the first 100 consecutive patients were compared with the second 100 patients. Target parameters were major adverse cardiac events (MACEs), including cardiac death, any myocardial infarction, and percutaneous or surgical target lesion revascularization (TLR). Target vessel failure (TVF) comprised cardiac death, target vessel myocardial infarction, and percutaneous or surgical target vessel revascularization (TVR).
  
  
  RESULTS
  Baseline characteristics were not significantly different. Post-dilatation was used significantly more often in the second group (23.8% vs. 50.5%, p<0.05) as was intravascular imaging (9% vs. 19%, p<0.05). In-hospital MACEs (2.0% for both groups) and median duration of hospital stay (4 (2-6)days) did not differ significantly. During a follow-up of 210 (155-369) or 200 (176-286)days (p=n.s.) for the first and second groups, respectively, MACE (11.2% vs. 1.1%, p<0.01), TVF (10.1% vs. 1.1%, p<0.01), and TVR (9.9% vs. 1.1%, p<0.05) rates were significantly lower in the second group.
  
  
  CONCLUSIONS
  There is evidence of a learning curve. Post-dilatation is most probably associated with an improved clinical result and intravascular imaging might be useful for further improvement.
authors.affiliation: University of Giessen, Medizinische Klinik I, Department of Cardiology, Klinikstrasse 33, 35392 Giessen, Germany. Electronic address: jens.wiebe@googlemail.com.
authors.forename: Jens
authors.initials: J
authors.lastname: Wiebe
authors.affiliation: University of Giessen, Medizinische Klinik I, Department of Cardiology, Klinikstrasse 33, 35392 Giessen, Germany; Kerckhoff Heart and Thorax Center, Department of Cardiology, Benekestrasse 2-8, 61231 Bad Nauheim, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Liebetrau
authors.affiliation: University of Giessen, Medizinische Klinik I, Department of Cardiology, Klinikstrasse 33, 35392 Giessen, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Dörr
authors.affiliation: University of Giessen, Medizinische Klinik I, Department of Cardiology, Klinikstrasse 33, 35392 Giessen, Germany.
authors.forename: Eva
authors.initials: E
authors.lastname: Wilkens
authors.affiliation: University of Giessen, Medizinische Klinik I, Department of Cardiology, Klinikstrasse 33, 35392 Giessen, Germany.
authors.forename: Timm
authors.initials: T
authors.lastname: Bauer
authors.affiliation: Heart Center Oldenburg, Department of Cardiology, Rahel-Straus-Strasse 10, 26133 Oldenburg, Germany.
authors.forename: Albrecht
authors.initials: A
authors.lastname: Elsässer
authors.affiliation: University of Erlangen, Medizinische Klinik II, Department of Cardiology, Ulmenweg 18, 91054 Erlangen, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Achenbach
authors.affiliation: Kerckhoff Heart and Thorax Center, Department of Cardiology, Benekestrasse 2-8, 61231 Bad Nauheim, Germany.
authors.forename: Helge
authors.initials: H
authors.lastname: Möllmann
authors.affiliation: University of Giessen, Medizinische Klinik I, Department of Cardiology, Klinikstrasse 33, 35392 Giessen, Germany; Kerckhoff Heart and Thorax Center, Department of Cardiology, Benekestrasse 2-8, 61231 Bad Nauheim, Germany.
authors.forename: Christian W
authors.initials: CW
authors.lastname: Hamm
authors.affiliation: University of Giessen, Medizinische Klinik I, Department of Cardiology, Klinikstrasse 33, 35392 Giessen, Germany.
authors.forename: Holger M
authors.initials: HM
authors.lastname: Nef
mesh_terms: D020341:Absorbable Implants; D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D000068338:Everolimus / Q000494:pharmacology*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D059032:Learning Curve; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000068338:Everolimus
keywords: Bioresorbable scaffold; Coronary artery disease; Learning curve; Percutaneous coronary intervention