Effect of Post-Dilatation Following Primary PCIWith Everolimus-Eluting Bioresorbable Scaffold Versus Everolimus-Eluting Metallic Stent Implantation An Angiographic and Optical Coherence Tomography TROFI II Substudy

OBJECTIVES This study sought to investigate the effect of post-dilatation on angiographic and intracoronary imaging parameters in the setting of primary percutaneous coronary intervention comparing the everolimus-eluting bioresorbable scaffold (BRS) with the everolimus-eluting metallic stent (EES). BACKGROUND Routine post-dilatation of BRS has been suggested to improve post-procedural angiographic and subsequent device-related clinical outcomes. METHODS In the ABSORB STEMI TROFI II trial, 191 patients with ST-segment elevation myocardial infarction were randomly assigned to treatment with BRS (n = 95) or EES (n = 96). Minimal lumen area and healing score as assessed by optical coherence tomography at 6 months were compared between BRS-and EES-treated patients stratified according to post-dilatation status. RESULTS Primary percutaneous coronary intervention with post-dilatation was performed in 48 (50.5%) BRS-and 25 (25.5%) EES-treated lesions. There were no differences in baseline characteristics and post-procedural minimal lumen diameter between groups. In the BRS group, lesions with post-dilatation were associated with a trend toward a smaller minimal lumen area at 6 months (5.07 +/- 1.68 mm(2) vs. 5.72 +/- 1.77 mm(2); p = 0.09) and significantly larger angiographic late lumen loss (0.28 +/- 0.34mmvs. 0.12 +/- 0.25 mm; p = 0.02), whereas no difference was observed in the EES arm (5.46 +/- 2.18 mm(2) vs. 5.55 +/- 1.77 mm(2); p = 0.85). The neointimal healing score was low and comparable between groups with and without post-dilation (BRS: 1.55 +/- 2.61 vs. 1.92 +/- 2.17; p = 0.48; EES: 2.50 +/- 3.33 vs. 2.90 +/- 4.80; p = 0.72). CONCLUSIONS In the setting of selected patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention with BRS or EES, post-dilatation did not translate into larger lumen area or improved arterial healing at follow-up. (C) 2017 by the American College of Cardiology Foundation.