EuroPCR 2026 | Coronary bioadaptor: fewer events regardless of IVUS or FFR guidance

Despite the increasing use of intracoronary imaging and physiology, stent-related events continue to occur at an annual rate of approximately 2–3% beyond the first year after PCI. In this context, the DynamX system emerged as a coronary bioadaptor designed to provide initial vessel support and subsequently restore part of the vessel’s physiological function.

The device features a metallic helical structure connected by a bioabsorbable polymer that, after approximately 6 months, partially releases its components, allowing restoration of pulsatility, conformability, and adaptive vascular remodeling. This subanalysis of the INFINITY-SWEDEHEART trial evaluated whether the clinical benefit of the bioadaptor was maintained regardless of the use of intracoronary imaging (IVUS/OCT) or coronary physiology (FFR/iFR).

The primary endpoint was Target Lesion Failure (TLF) between 6 and 24 months, assessing superiority compared with a contemporary DES. Results were analyzed according to the guidance strategy used: intracoronary imaging/physiology versus conventional angiography.

The INFINITY-SWEDEHEART trial included 2,400 patients across 20 centers in Sweden, randomized 1:1 to the DynamX bioadaptor (1,201 patients) or Resolute Onyx DES (1,198 patients). Approximately 25% of procedures were guided by IVUS/OCT or coronary physiology, while the remaining 75% were performed using angiography alone. The population represented a complex clinical setting, with a high prevalence of acute coronary syndrome, long lesions, and complex B2/C lesions. Clinical follow-up at 2 years reached 100%.

Read also: EuroPCR 2026 | Restoring vascular physiology: 4-year results of the BIOADAPTOR-RCT.

In the overall analysis, the bioadaptor demonstrated a significant reduction in TLF between 6 months and 2 years compared with the contemporary DES (1.5% vs 2.8%; p=0.0245). The benefit was observed both in image/physiology-guided procedures and in those guided exclusively by angiography. In the intracoronary guidance group, TLF rates were 1.0% with the bioadaptor versus 2.5% with DES, while in angiography-guided procedures, rates were 1.6% versus 2.9%, respectively. No significant interaction was observed between the type of guidance used and the device effect.

The authors also highlighted that the lower event rates became evident after 6 months, coinciding with the time when the device acquires its dynamic behavior following polymer resorption. Additionally, the use of IVUS/OCT or coronary physiology showed a trend toward lower TLF, in line with current European guideline recommendations for complex PCI.

Conclusion: The DynamX bioadaptor reduced target lesion failure regardless of IVUS or FFR guidance

This subanalysis of the INFINITY-SWEDEHEART trial demonstrated that the DynamX coronary bioadaptor was associated with lower rates of target lesion failure compared with a contemporary DES, regardless of the use of intracoronary imaging or coronary physiology.

Original Title: Impact of Imaging- or Physiology-Guided Coronary Revascularization on Long Term Outcomes with Bioadaptor Implant: Insights from the INFINITY-SWEDEHEART Trial.

Reference: Presentado por David Erlinge en EuroPCR 2026.