ImpaCt of an Optimal Implantation Strategy on Absorb Long-Term Outcomes: The CIAO Registry

• Published in: Cardiovascular revascularization medicine Vol. 30; pp. 1 - 8
• Main Authors: Rapetto, Claudio, Leoncini, Massimo, Cerrato, Enrico, Regazzoli, Damiano, Cortese, Bernardo, Rossi, Angelica, Fetiveau, Raffaela, Geraci, Salvatore, De Angelis, Maria Carmen, Tespili, Maurizio, Iannaccone, Mario, Centola, Antonio, Durante, Alessandro, De Carlo, Marco, De Caterina, Alberto, Ribichini, Flavio, Favaretto, Enrico, Testa, Luca, Pirisi, Raimondo, Varbella, Ferdinando, Nicolini, Elisa, di Palma, Gaetano, Loi, Bruno, Poli, Arnaldo, Caramanno, Giuseppe, Varricchio, Attilio, Garbo, Roberto, Cuculo, Andrea, Petronio, Anna Sonia, Berti, Sergio, Bollati, Mario, Spedicato, Leonardo, De Candia, Gianfranco, Piva, Tommaso, Quadri, Giorgio, Colombo, Antonio, Ielasi, Alfonso
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.09.2021
• Subjects: Bioresorbable scaffold; Coronary artery disease; Percutaneous coronary intervention; Bioresorbable scaffold; Coronary artery disease; Percutaneous coronary intervention
• ISSN: 1553-8389; 1878-0938
• DOI: 10.1016/j.carrev.2020.09.036

To compare the long-term outcomes of patients implanted with Absorb bioresorbable scaffold (BRS) with optimal versus suboptimal technique. All patients who received an Absorb between March 2012 and January 2016 were selected from 19 Italian centers databases to assess the impact of an optimal implantation technique (CIAO criteria) on long-term device-oriented composite end-point (DOCE) - including cardiac death (CD), target-vessel myocardial infarction (TV-MI) and ischemia-driven target lesion revascularization (ID-TLR) - on its single components and on scaffold thrombosis (ScT). CIAO criteria consist of predilation (balloon/vessel ratio 1:1), correct sizing (BRS/proximal reference vessel diameter -RVD- ratio 0.8–1.2) and high-pressure postdilation with non-compliant (NC) balloon (≥20 atm for balloon/BRS ratio 1:1 or ≥16 atm for a 0.25–0.5 mm oversized balloon). Among the 1.434 patients analyzed, 464 (32.4%) fulfilled all CIAO criteria for every BRS implanted (CIAO 3 group), while 970 (67.6%) did not in at least one of the received BRS (CIAO 0-1-2 group). At 31.0 (interquartile range -IQR- 24.8–38.5) months follow-up, CIAO criteria did not impact on DOCE (8.2% vs. 8.0%, p = 0.92), ID-TLR (6.9% vs. 7.1%, p = 0.72) or ScT (1.9% vs. 1.8%, p = 0.80) in the overall population. At multivariate analysis overall BRS length (p = 0.001), severely calcified lesions (p = 0.03) and absence of CIAO criteria (CIAO 0, p = 0.005) were independent predictors of DOCE in long-term follow-up. Our data suggest that strict application of an optimal Absorb implantation technique doesn't improve long-term DOCE or ScT but may mitigate the worse outcome of patients with calcific lesions. •Acceptable 3-year DOCE and definite ScT (8.1%, 1.5%), better than many BRS studies•Optimal BRS implantation absence (CIAO 0) severely affects 3-year DOCE.•No 3-year ScT differences between optimal (CIAO 3) and suboptimal BRS implants•Severely calcified lesions have poorer 3-year DOCE than less/no-calcified lesions.•Optimal BRS implant (CIAO 3) nullifies calcium detrimental effect on DOCE.