• Joo Myung Lee, Hyun Sung Joh, Ki Hong Choi, David Hong, Taek Kyu Park, Jeong Hoon Yang, Young Bin Song, Jin-Ho Choi, Seung-Hyuk Choi, Jin-Ok Jeong, Jong-Young Lee, Young Jin Choi, Jei-Keon Chae, Seung-Ho Hur, Jang-Whan Bae, Ju-Hyeon Oh, Kook-Jin Chun, Hyun-Joong Kim, Byung Ryul Cho, Doosup Shin, Seung Hun Lee, Doyeon Hwang, Hyun-Jong Lee, Ho-Jun Jang, Hyun Kuk Kim, Sang Jin Ha, Eun-Seok Shin, Joon-Hyung Doh, Joo-Yong Hahn, Hyeon-Cheol Gwon, and SMART-REWARD Investigators.
• Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
• J. Korean Med. Sci. 2023 Feb 6; 38 (5): e34e34.

BackgroundThe risk of device thrombosis and device-oriented clinical outcomes with bioresorbable vascular scaffold (BVS) was reported to be significantly higher than with contemporary drug-eluting stents (DESs). However, optimal device implantation may improve clinical outcomes in patients receiving BVS. The current study evaluated mid-term safety and efficacy of Absorb BVS with meticulous device optimization under intravascular imaging guidance.MethodsThe SMART-REWARD and PERSPECTIVE-PCI registries in Korea prospectively enrolled 390 patients with BVS and 675 patients with DES, respectively. The primary endpoint was target vessel failure (TVF) at 2 years and the secondary major endpoint was patient-oriented composite outcome (POCO) at 2 years.ResultsPatient-level pooled analysis evaluated 1,003 patients (377 patients with BVS and 626 patients with DES). Mean scaffold diameter per lesion was 3.24 ± 0.30 mm in BVS group. Most BVSs were implanted with pre-dilatation (90.9%), intravascular imaging guidance (74.9%), and post-dilatation (73.1%) at proximal to mid segment (81.9%) in target vessel. Patients treated with BVS showed comparable risks of 2-year TVF (2.9% vs. 3.7%, adjusted hazard ratio [HR], 1.283, 95% confidence interval [CI], 0.487-3.378, P = 0.615) and 2-year POCO (4.5% vs. 5.9%, adjusted HR, 1.413, 95% CI, 0.663-3.012, P = 0.370) than those with DES. The rate of 2-year definite or probable device thrombosis (0.3% vs. 0.5%, P = 0.424) was also similar. The sensitivity analyses consistently showed comparable risk of TVF and POCO between the 2 groups.ConclusionWith meticulous device optimization under imaging guidance and avoidance of implantation in small vessels, BVS showed comparable risks of 2-year TVF and device thrombosis with DES.Trial RegistrationClinicalTrials.gov Identifier: NCT02601404, NCT04265443.© 2023 The Korean Academy of Medical Sciences.

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