Hybrid Coronary Percutaneous Treatment with Metallic Stents and Everolimus-Eluting Bioresorbable Vascular Scaffolds: 2-years Results from the GABI-R Registry

Tommaso Gori, Stephan Achenbach, Thomas Riemer, Julinda Mehilli, Holger M Nef, Christoph Naber, Gert Richardt, Jochen Wöhrle, Ralf Zahn, Till Neumann, Johannes Kastner, Axel Schmermund, Christian Hamm, Thomas Münzel, Tommaso Gori, Stephan Achenbach, Thomas Riemer, Julinda Mehilli, Holger M Nef, Christoph Naber, Gert Richardt, Jochen Wöhrle, Ralf Zahn, Till Neumann, Johannes Kastner, Axel Schmermund, Christian Hamm, Thomas Münzel

Abstract

The limitations of the first-generation everolimus-eluting coronary bioresorbable vascular scaffolds (BVS) have been demonstrated in several randomized controlled trials. Little data are available regarding the outcomes of patients receiving hybrid stenting with both BVS and drug-eluting stents (DES). Of 3144 patients prospectively enrolled in the GABI-Registry, 435 (age 62 ± 10, 19% females, 970 lesions) received at least one BVS and one metal stent (hybrid group). These patients were compared with the remaining 2709 (3308 lesions) who received BVS-only. Patients who had received hybrid stenting had more frequently a history of cardiovascular disease and revascularization (p < 0.05), had less frequently single-vessel disease (p < 0.0001), and the lesions treated in these patients were longer (p < 0.0001) and more frequently complex. Accordingly, the incidence of periprocedural myocardial infarction (p < 0.05) and that of cardiovascular death, target vessel and lesion failure and any PCI at 24 months was lower in the BVS-only group (all p < 0.05). The 24-months rate of definite and probable scaffold thrombosis was 2.7% in the hybrid group and 2.8% in the BVS-only group, that of stent thrombosis in the hybrid group was 1.86%. In multivariable analysis, only implantation in bifurcation lesions emerged as a predictor of device thrombosis, while the device type was not associated with this outcome (p = 0.21). The higher incidence of events in patients receiving hybrid stenting reflects the higher complexity of the lesions in these patients; in patients treated with a hybrid strategy, the type of device implanted did not influence patients´ outcomes.

Keywords: coronary artery disease; drug eluting stents; stent bioresorbable.

Conflict of interest statement

Holger Nef: Research grants (institutional) and speaker honoraria—Abbott Vascular, Gert Richart: Advisory board—Abbott Vascular, Stephan Achenbach: Research grants (institutional)—Abbott Vascular and Siemens Healthcare, Julinda Mehilli: Speaker´s honoraria and advisory board—Abbot Vascular, research grant (institutional)—Abbott Vascular; Axel Schmermund: Speaker honorarium—Abbott Vascular, Christian Hamm: Speaker honorarium—Abbott Vascular. Tommaso Gori: Research grants (institutional), advisory board and speaker honoraria—Abbott Vascular. Other authors did not report conflicts of interest.

Figures

Figure 1
Figure 1
Study flow per patient (left panel) and per lesion (right).
Figure 2
Figure 2
Two-years rates of target lesion revascularization. Comparison of Patients treated with hybrid vs. BVS-only strategy.
Figure 3
Figure 3
(A) Two-years incidence of device thrombosis. There was no difference among lesions treated with BVS only, metal stents only, or hybrid strategies; (B) cumulative incidence curves showing an overlap of the confidence intervals.

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