Long-Term Safety and Efficacy of Bioresorbable Vascular Scaffolds Versus Metallic Stents Compared in Meta-Analysis

 

May 8, 2017—A meta-analysis of randomized trials evaluating the long-term safety and efficacy of everolimus-eluting bioresorbable vascular scaffolds (BVS) versus everolimus-eluting metallic stents (EES) was published by Ahmed N. Mahmoud, MD, et al online ahead of print in Circulation: Cardiovascular Interventions.

The investigators concluded that in these studies, BVS, compared with EES, was associated with an increased risk of target lesion failure driven by the increased rates of target vessel myocardial infarction and ischemia-driven target lesion revascularization. The risk of definite or probable stent/scaffold thrombosis and very late stent/scaffold thrombosis seems to be higher with BVS. Further information from randomized trials is critical to evaluate clinical outcomes with BVS on complete resolution of the scaffold, advised the investigators.

As summarized in Circulation: Cardiovascular Interventions, the meta-analysis included randomized trials reporting clinical outcomes beyond 1 year and comparing BVS with EES. Summary estimates of risk ratios (RRs) were constructed. The primary efficacy outcome was target lesion failure, defined as cardiac death, target vessel myocardial infarction, and ischemia-driven target lesion revascularization, and the primary safety outcome was definite or probable stent/scaffold thrombosis. Six trials with 5,392 patients were included (mean follow-up, 25 months).

The investigators found that BVS had a higher rate of target lesion failure (RR, 1.33; 95% confidence interval [CI], 1.11–1.58) driven by the higher rates of target vessel myocardial infarction (RR, 1.65; 95% CI, 1.26–2.17) and target lesion revascularization (RR, 1.39; 95% CI, 1.08–1.78). The risk of definite or probable stent/scaffold thrombosis (RR, 3.22; 95% CI, 1.89–5.49) and very late stent/scaffold thrombosis (> 1 year; RR, 4.78; 95% CI, 1.66–13.8) was higher with BVS. The risk of cardiac and all-cause mortality was similar in both groups, reported the investigators in Circulation: Cardiovascular Interventions.

 

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Cardiac Interventions Today is a publication dedicated to providing comprehensive coverage of the latest developments in technology, techniques, clinical studies, and regulatory and reimbursement issues in the field of coronary and cardiac interventions. Cardiac Interventions Today premiered in March 2007, with its launch issue focusing on the state of coronary drug-eluting stent use. Each edition will cover a variety of topics in a flexible format that includes articles covering various perspectives on current clinical topics, in-depth interviews with expert physicians, overviews of available technologies, industry news, and insights into the issues affecting today's cardiology practices.