Effect of Technique on Outcomes Following Bioresorbable Vascular Scaffold Implantation

Background: Procedural technique may affect clinical outcomes after bioresorbable vascular scaffold (BVS) implantation. Prior studies suggesting such a relationship have not adjusted for baseline patient and lesion characteristics that may have influenced operator choice of technique and outcomes.
Objectives: This study sought to determine whether target lesion failure (TLF) (cardiac death, target-vessel myocardial infarction, or ischemia-driven target lesion revascularization) and scaffold thrombosis (ScT) rates within 3 years of BVS implantation are affected by operator technique (vessel size selection and pre- and post-dilation parameters).
Methods: TLF and ScT rates were determined in 2,973 patients with 3,149 BVS-treated coronary artery lesions from 5 prospective studies. Outcomes through 3 years were assessed according to pre-specified definitions of optimal technique. Multivariable analysis was used to adjust for differences in up to 18 patient and lesion characteristics.
Results: Optimal pre-dilation, vessel size selection, and post-dilation in all BVS-treated lesions were performed in 59.2%, 81.6%, and 12.4% of patients, respectively. BVS implantation in properly sized vessels was an independent predictor of freedom from TLF through 1 year and through 3 years, and of freedom from ScT through 1 year. Aggressive pre-dilation was an independent predictor of freedom from ScT between 1 and 3 years, and optimal post-dilation was an independent predictor of freedom from TLF between 1 and 3 years.
Conclusions: In the present large-scale analysis from the major ABSORB studies, after multivariable adjustment for baseline patient and lesion characteristics, vessel sizing and operator technique were strongly associated with BVS-related outcomes during 3-year follow-up.