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MINISTRY OF EDUCATION MINISTRY OF HEALTH AND TRAINING HANOI MEDICAL UNIVERSITY HOANG VIET ANH EVALUATION OF THE RESULTS OF CORONARY INTERVENTION BY ABSORB STENT (BVS) Major Code : Internal Cardiology : 62720141 MEDICAL DOCTORATE THESIS HANOI - 2020 THE THESIS WAS FULFILLED AT HANOI MEDICAL UNIVERSITY Scientific Supervisor: Prof Ph.D Nguyễn Quang Tuấn 1st Peer-reviewer: Prof Ph.D Đỗ Doãn Lợi 2nd Peer-reviewer: Assoc Prof Ph.D Phạm Nguyên Sơn 3nd Peer-reviewer: Assoc Prof Ph.D Nguyễn Oanh Oanh Ph.D Thesis will be evaluated by the Hanoi medical University Thesis Board At h / / /2020 The thesis can be found at: - National Library - Hanoi medical University Library LIST OF PUBLICATIONS RELATED TO THE THESIS Hoang Viet Anh, Nguyen Quang Tuan, Nguyen Quoc Thai (2018) The preliminary result of Absorb (BVS) implantation in patients with acute coronary syndrome Vietnam Medical Journal ,472(2),pp 124-127 Hoang Viet Anh, Nguyen Quang Tuan, Nguyen Quoc Thai (2018) The safety and feasibility of Absorb (BVS) in patients with coronary bifurcation disease Vietnam Medical Journal ,472(2),pp 87-90 1 Introduction Coronary artery disease (CAD) is still the leading cause of death in the world with 17.5 million cases reported in 2012 and is expected to increase to 23 million cases by 2030 According to statistics in the United States in 2018, coronary deaths accounted for 43.8% of the causes of cardiovascular deaths Besides, from 2011 to 2014, it was estimated that there were 16.5 million people with ischemic heart disease and 720,000 new cases each year In Europe, coronary mortality also accounted for 40% of cardiovascular deaths In Vietnam, CAD has increased rapidly in recent years According to statistics at the Vietnam National Heart Institute - Bach Mai Hospital, CAD incidence in 1994, 1995, 1996 were 3.4%, 5.0% and 6.0%, respectively; by 2003 this rate was 11.2%; in 2005 it was 18.8% and in 2007 it was 24% Medical treatment, coronary intervention and coronary bypass surgery are three effective treatments for coronary artery disease Coronary intervention was started in 1977 when Andreas Gruntzig conducted the world's first human balloon angioplasty case With the introduction of Plain Old Balloon Angioplastyn (POBA), followed by Bare Metal Stent (BMS) and Drug- Eluting Stent (DES), it has proved the safety and efficacy of CAD treatment However, once the coronary artery is treated the stent's support function will no longer be necessary and the regular presence of metal stent will theoretically pose serious problems The long-term existence of a metal frame in the lumen can affect vascular endothelial function, physiological vasomotor performance, and interfere with the image of non-invasive coronary diagnoses (MSCT, MRI) and may be difficult for future coronary revascularization, such as coronary reintervention or coronary bypass surgery Therefore, the introduction of Bioabsorbable vascular scaffolds - BVS, BRS, which is able to support the vessel wall in the first time when needed and then disappear, helps the natural regeneration and healing process of the vascular wall and prevents possible risks such as metal stent Absorb stent (Abbott - USA) has a frame of Poly - L lactic acid, covered with anti-re-narrowing drug everolimus, with a resorbable time of to years, has many promising treatments for coronary artery disease Of the BVS, this is the most used stent in the world with 150,000 patients with the most number of studies and the longest follow-up time The meta analysis has shown that Absorb stent helps to preserve physiological vasomotion, coronary morphology and clinical outcomes with many promises However, in Vietnam, there have been no studies on Absorb stent Therefore, we implement the study "Evaluation of the resrults of coronary intervention by Absorb stent (BVS)" with the following two goals: Assessment of early and medium-term results (after 12 months) of Absorb stent (BVS) in coronary intervention Assessment of the late lumen loss with Absorb stent (BVS) by QCA Topicality of thesis The thesis was started in 2013, at the time when studies with BVS in general and Absorb stent in particular have very promising initial results in the treatment of coronary stenosis The thesis was initiated in 2013 when studies on BVS in general and Absorb stent in particular achieved their very first promising results in treatment of coronary stenosis Given that non-communicable diseases, including coronary stenosis, have become more commonplace in Vietnam and worldwide, together with the rise in related diseases such as diabetes mellitus, hypertension, and dyslipidemia, this study is of great importance in the current context in Vietnam Scientific contributions of the thesis This is a study to evaluate the results of Absorb stenting procedure (Abbott Vascular, USA) for patients with new coronary lesions and study the extent of coronary artery narrowing after intervention (LLL) with this technique in Viet Nam The results of the study show: The early outcome (immediatetly after the intervention): Clinical device success is 97.5%; Clinical procedure success is 96.25% Peri-procedural device-oriented composite endpoint (DoCE) is 1.25% with peripocedural myocardial infarction case Acute change in lesion angulation, with decrease in angulation, is 5,593,72 degree Independent predictors of smaller change in angulation are: male sex and BVS, etc.) can be used for up to 24 months or more if there is no high risk of bleeding 4.1.6 Coronary angiography In our study, the average procedure time was 41.013.0 minutes This time is similar to the Absorb III study was (4223 minutes) The reason for increasing the time of Absorb interventions according to many studies is that lesions often have to be prepared, stent gradually pressurized in a separate process (2atm / seconds), post dilatation, special techniques like PSP and specifically for invasive imaging diagnostics (IVUS, OCT) The average amount of contrast used was 151.0 44.03 ml The reason is that Absorb stent is not radiopaque so it is harder to identify than DES The most common culprit in our study was the LAD (64.6%), which is quite high compared to other studies Studies have shown that one of the preferred lesion sites to use BVS over BMS is middle LAD The reason for this is that in the long term it is possible to release the metal frame and provide a place CABG in the future However, LAD is also an independent prognostic factor that increases DoCE The coronary artery lesion is only a lesion, on vessel, the diameter of the missing vascular part of our study is much larger, but the length of the lesion is longer than that of other Absorb studies However, complex lesions (B2 + C) is 19 lower than other studies Studies show that small coronary artery is an independent prognostic factor of MACE Therefore, the recommendation of Abbott (United States) is the contraindication to use Absorb stent for small coronary arteries with a reference diameter
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