Seven‐Year Clinical Outcomes of a Magnesium Bioresorbable Scaffold in Acute Coronary Syndrome: A Door Opened for the Next Generation

ABSTRACT Background Magnesium‐based bioresorbable scaffolds (MgBRS) offer theoretical advantages over permanent metallic stents in percutaneous coronary intervention, particularly for younger patients or those with vulnerable plaques in acute coronary syndrome (ACS). However, early clinical outcomes with MgBRS have been inconsistent, and long‐term data remain scarce. Aims To evaluate 7‐year clinical outcomes in ACS patients treated with MgBRS, and to compare event rates between early (24 ± 7 months) and late (6.7 ± 0.6 years) follow‐up periods. Methods This prospective, multicenter, observational study included 90 ACS patients treated with MgBRS between 2016 and 2018. The primary endpoint was the device‐oriented composite endpoint (DOCE), defined as the composite of cardiac or unknown death, target vessel myocardial infarction, and target lesion revascularization (TLR). Secondary endpoints included each individual component of the DOCE and scaffold thrombosis (ST). All patients completed long‐term clinical follow‐up. Results DOCE occurred in 15.5% (14/90) of patients, with 85.7% (12/14) of events taking place during the first follow‐up period. This included the 82% (9/11) of TLRs. In contrast, only 2.5% (2/78) of patients experienced DOCE beyond 24 months ( p = 0.01). Notably, all ST events (2.2%) occurred exclusively during the initial follow‐up phase. Conclusions In ACS patients, the first‐generation MgBRS demonstrates a biphasic temporal safety profile, marked by early vulnerability followed by sustained long‐term safety after scaffold resorption. These findings open the door to renewed hope for the future role of magnesium‐based scaffolds in coronary interventions.