A higher rate of bioresorbable vascular scaffold (BVS) thrombosis has been observed after device implantation compared to implantation of permanent metallic stents in recently published studies. The mechanism of BVS thrombosis is currently under debate. To assess whether the immune-inflammatory response after BVS implantation is a potential trigger of BVS thrombosis. The PRAGUE-19 study was an academic study that enrolled consecutive patients with ST-segment elevation myocardial infarction (STEMI) with the intention to implant a BVS. A laboratory sub-study included 49 patients with an implanted BVS (of which 38 underwent the complete 2-year follow-up) and 52 patients having an implanted permanent metallic stent as the control group (of which 30 underwent the complete 2-year follow-up). Samples for inflammatory markers [high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α)] were taken before BVS or stent implantation, on days 1 and 2 after device implantation and at 1 month and 2 years for a clinical control. The primary combined clinical endpoint of the sub-study (death, reinfarction or target vessel revascularization) occurred in 4.08% of the BVS group and 7.69% of the control group (p = 0.442) during the 2-year follow-up period, with overall mortality of 2.04% in the BVS group and 1.92% in the control group (p = 0.966). Definite BVS thrombosis occurred in one patient in the subacute phase; there was no late or very late thrombosis. Two definite stent thromboses were observed in the control group: one in the subacute phase and the other in the late phase. Baseline inflammatory marker levels did not differ between the groups. Lower levels of IL-6 and hs-CRP were observed in the BVS group compared to the control group (12.02 ± 5.94 vs. 15.21 ± 5.33 pg/ml; p < 0.01; 3952.9 ± 1704.75 ng/ml vs. 4507.49 ± 1190.01 ng/ml; p = 0.037, respectively) on days 1 and 2 (12.01 ± 6.31 vs. 13.85 ± 6.01 pg/ml; p = 0.089; 4447.92 ± 1325.31 ng/ml vs. 4637.03 ± 1290.99 ng/ml; p = 0.255, respectively). No differences in IL-6 or hs-CRP were observed after 1 month or 2 years in the clinical control. Levels of TNF-α did not differ between the groups in the early period after BVS or metallic stent implantation, nor during follow-up. The immune-inflammatory response is lower during the early phase after BVS implantation compared to that after metallic stent implantation, but the responses did not differ in the long term.

Cardiocenter 3rd Faculty of Medicine Charles University and University Hospital Královské Vinohrady Ruská 87 Prague 10 Czech Republic

Zobrazit více v PubMed

J Am Coll Cardiol. 1998 Jun;31(7):1460-5 PubMed

Coron Artery Dis. 2005 Dec;16(8):505-9 PubMed

Eur Heart J. 1993 Jul;14(7):915-9 PubMed

Lancet. 2007 Feb 24;369(9562):667-78 PubMed

JACC Cardiovasc Interv. 2016 Jun 27;9(12):1203-12 PubMed

J Interv Cardiol. 2014 Apr;27(2):142-54 PubMed

JACC Cardiovasc Interv. 2009 Apr;2(4):291-9 PubMed

JACC Cardiovasc Interv. 2016 Jan 11;9(1):12-24 PubMed

Eur Heart J. 1996 Sep;17(9):1345-9 PubMed

Clin Cardiol. 2001 Nov;24(11):701-4 PubMed

Mediators Inflamm. 2011;2011:565238 PubMed

JAMA. 2005 May 4;293(17):2126-30 PubMed

Am J Cardiol. 2000 Nov 1;86(9):913-8 PubMed

Lancet. 2016 Mar 26;387(10025):1277-89 PubMed

N Engl J Med. 2007 Mar 8;356(10):1030-9 PubMed

N Engl J Med. 1999 Feb 11;340(6):448-54 PubMed

Heart Vessels. 2016 Jun;31(6):841-5 PubMed

BMJ. 1996 Apr 27;312(7038):1061-5 PubMed

Lancet. 2007 Sep 15;370(9591):937-48 PubMed

Circulation. 2010 Jul 6;122(1):52-61 PubMed

N Engl J Med. 2007 Mar 8;356(10):998-1008 PubMed

Arterioscler Thromb Vasc Biol. 2007 Jul;27(7):1500-10 PubMed

JACC Cardiovasc Interv. 2014 Jan;7(1):64-71 PubMed

JACC Cardiovasc Interv. 2013 Dec;6(12):1267-74 PubMed

Eur Heart J. 2014 Mar;35(12):787-94 PubMed

Circulation. 2007 Mar 20;115(11):1440-55; discussion 1455 PubMed

Circulation. 2012 Mar 6;125(9):1110-21 PubMed

Int J Cardiol. 2007 Aug 21;120(2):212-20 PubMed

Eur Heart J. 2015 Aug 21;36(32):2147-59 PubMed