[Bioresorbable vascular scaffolds - is therapy already at an end or is there a renaissance?] / Bioresorbierbare vaskuläre Scaffolds.

Bioresorbable vascular scaffolds - is therapy already at an end or is there a renaissance? Abstract. The principle of bioresorbable vascular scaffolds is a good approach to solving the residual problem of percutaneous coronary interventions, which despite the introduction and immense further development of metal stents have shown a continuous increase in undesirable events over the years. As an advantage, bioresorbable vascular scaffolds can on the one hand ensure the restoration of the physiological vascular properties; on the other hand - after resorption - in contrast to permanent metal implants, the cause of the development of in-stent re-stenoses or late stent thromboses, which still represent the greatest limitation of the metal stents, is resolved. The first real representative of the bioresorbable vascular scaffolds (Absorb) was able to deliver good results initially; but that could not be confirmed in the end, so that it was withdrawn from the market. However, important insights were gained from the error analyzes that influenced the further development of the currently approved scaffolds, so that scaffolds are now on the market that have a strut thickness comparable to metal stents and thereby produce good study results. Even if the number of patients treated and the quality of the studies are not yet sufficient to change the current European guidelines, which are solely based on the Absorb-data; there is a promising data situation now compared to 2018 when the guidelines were written. The promising results of the studies in the treatment of infrapopliteal stenosis and the attendance of manufacturers to work on further product generations show that the therapy with BRS is far from over but is - after a bumpy start - at the beginning of a renaissance.

Heart failure is associated with an increased incidence of cancer diagnoses.

AIMS: The prognosis and quality of life of heart failure patients is determined to a significant extent by co-morbidities. New data suggest that heart failure may be associated with an increased incidence of cancer. The present retrospective study investigates this association in a large collective of outpatients with heart failure. METHODS AND RESULTS: This retrospective cohort study assessed the incidence of cancer in patients with an initial diagnosis of heart failure and a matched non-heart failure cohort in 1274 general practices in Germany between January 2000 and December 2018. The study is based on the Disease Analyser database (IQVIA), which contains drug prescriptions, diagnoses, and basic medical and demographic data. Hazard regression models were used to study the association between heart failure and the incidences of different cancers. A total of 100 124 patients with heart failure and 100 124 patients without heart failure were included in the analysis. Patients were matched individually by sex, age, diabetes, obesity, and yearly consultation frequency. Within the 10 year observation period, 25.7% of patients with heart failure and 16.2% of patients without heart failure had been diagnosed with cancer (log-rank P < 0.001). These proportions were 28.6% vs. 18.8% in female and 23.2% vs. 13.8% in male patients. Heart failure was significantly associated with the incidence of cancer [hazard ratio (HR), 95% confidence interval: 1.76, 1.71-1.81; P < 0.001 in total; HR: 1.85, 1.77-1.92, P < 0.001 in women; HR: 1.69, 1.63-1.76, P < 0.001 in men]. A significant association was found between heart failure and all cancer sites assessed. The strongest association was observed for cancer of lip, oral cavity, and pharynx (HR: 2.10, 95% confidence interval: 1.66-2.17; P < 0.001), followed by respiratory organs (HR: 1.91, 1.74-2.10; P < 0.001) and genital organs of female patients (HR: 1.86, 1.56-2.17; P < 0.001). The association for skin tumours was 1.83 (1.72-1.94; P < 0.001), for cancer of lymphoid and haematopoietic tissue 1.77 (1.63-1.91; P < 0.001), for cancer of the digestive tract 1.75 (1.64-1. 87; P < 0.001), for breast cancer 1.67 (1.52-1.84; P < 0.001), for cancer of the genitourinary tract 1.64 (1.48-1.81; P < 0.001), and for male genital organ cancer 1.52 (1.40-1.66; P < 0.001). CONCLUSIONS: Our study indicates that heart failure patients experience a significantly higher incidence of cancer during the course of the disease.