Immune–inflammatory response after bioresorbable vascular scaffold implantation in patients with acute myocardial infarction with ST elevation in a long-term perspective

• Published in: Heart and vessels 2019-04, Vol.34 (4), p.557-563
• Main Authors: Kozel, Martin, Kočka, Viktor, Lisa, Libor, Buděšínský, Tomáš, Toušek, Petr
• Format: Article
• Language: English
• Subjects: Absorbable Implants; Adult; Aged; Biocompatibility; Biomedical Engineering and Bioengineering; Biomedical materials; C-reactive protein; Cardiac Surgery; Cardiology; Coronary Angiography; Cytokines - metabolism; Drug-Eluting Stents; Everolimus - pharmacology; Female; Follow-Up Studies; Heart attacks; Humans; Immunity, Innate; Immunosuppressive Agents - pharmacology; Implantation; Implants; Inflammation; Inflammatory response; Interleukin 6; Interleukins; Male; Markers; Medicine; Medicine & Public Health; Middle Aged; Myocardial infarction; Original Article; Patients; Percutaneous Coronary Intervention - instrumentation; Percutaneous Coronary Intervention - methods; Prosthesis Design; Retrospective Studies; Scaffolds; ST Elevation Myocardial Infarction - diagnosis; ST Elevation Myocardial Infarction - immunology; ST Elevation Myocardial Infarction - surgery; Stents; Surgical implants; Thromboembolism; Thrombosis; Time Factors; Tissue Scaffolds; Tumor necrosis factor-TNF; Tumor necrosis factor-α; Vascular Surgery
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-018-1281-7

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