title: Initial experience with everolimus-eluting bioresorbable vascular scaffolds for treatment of patients presenting with acute myocardial infarction: a propensity-matched comparison to metallic drug eluting stents 18-month follow-up of the BVS STEMI first study.
abstract: OBJECTIVE
  Limited data are currently available on midterm outcomes after implantation of everolimus-eluting bioresorbable vascular scaffolds (BVS) for treatment of acute ST-elevation myocardial infarction (STEMI).
  
  
  RESULTS
  Patients presenting with STEMI and undergoing primary percutaneous coronary intervention in the initial experience with BVS were evaluated and compared with patients treated with everolimus-eluting metal stents (EES) by applying propensity matching. Quantitative coronary angiography analysis, and 18-month clinical follow-up were reported. A total of 302 patients were analysed, 151 with BVS and 151 with EES. Baseline clinical characteristics were similar between groups. Final TIMI 3 flow was 87.4% vs. 86.1%, p=0.296. At 18-month follow-up, all-cause mortality was 2.8% vs. 3.0% in the BVS and EES groups respectively, p=0.99; the MACE rate was higher in the BVS group (9.8% vs. 3.6%, p=0.02); target lesion revascularisation was 5.7% vs. 1.3%, p=0.05. The 30-day MACE rate in BVS patients without post-dilatation was 6.8%, while in patients with post-dilatation it was 3.6%. Scaffold thrombosis (ST) occurred primarily in the acute phase (acute ST 2.1% vs. 0.7%, p=0.29; subacute 0.7% vs. 0.7%, p=0.99; late 0.0% vs. 0.0%; very late 1.5% vs. 0.0%, p=0.18). All three BVS cases with acute ST had no post-dilatation at the index procedure.
  
  
  CONCLUSIONS
  STEMI patients treated during the early experience with BVS had similar acute angiographic results as compared with the EES group. Clinical midterm follow-up data showed a higher clinical events rate compared with metal stents. The majority of clinical events occurred in the early phase after implantation and mainly in cases without post-dilatation. Optimisation of the implantation technique in the acute clinical setting is of paramount importance for optimal short and mid-term outcomes.
authors.affiliation: Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Jiang Ming
authors.initials: JM
authors.lastname: Fam
authors.forename: Cordula
authors.initials: C
authors.lastname: Felix
authors.forename: Robert Jan
authors.initials: RJ
authors.lastname: van Geuns
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Onuma
authors.forename: Nicolas M
authors.initials: NM
authors.lastname: Van Mieghem
authors.forename: Antonios
authors.initials: A
authors.lastname: Karanasos
authors.forename: Jors
authors.initials: J
authors.lastname: van der Sijde
authors.forename: Marcella
authors.initials: M
authors.lastname: De Paolis
authors.forename: Evelyn
authors.initials: E
authors.lastname: Regar
authors.forename: Marco
authors.initials: M
authors.lastname: Valgimigli
authors.forename: Joost
authors.initials: J
authors.lastname: Daemen
authors.forename: Peter
authors.initials: P
authors.lastname: de Jaegere
authors.forename: Felix
authors.initials: F
authors.lastname: Zijlstra
authors.forename: Roberto
authors.initials: R
authors.lastname: Diletti
mesh_terms: D020341:Absorbable Implants; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D054855:Drug-Eluting Stents; D000068338:Everolimus / Q000494:pharmacology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods; D000072657:ST Elevation Myocardial Infarction / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D002317:Cardiovascular Agents; D000068338:Everolimus