Three to four years outcomes of the absorb bioresorbable vascular scaffold versus second‐generation drug‐eluting stent: A meta‐analysis

• Published in: Catheterization and cardiovascular interventions 2020-02, Vol.95 (2), p.216-223
• Main Authors: Goel, Sunny, Pasam, Ravi Teja, Chava, Srilekha, Sharma, Abhishek, Malik, Bilal Ahmad, Ayzenberg, Sergey, Frankel, Robert, Shani, Jacob, Gidwani, Umesh
• Format: Article
• Language: English
• Subjects: absorb; bioresorbable vascular scaffolds; clinical outcomes; Clinical trials; drug‐eluting stents; Heart; Implants; Meta-analysis; Mortality; Myocardial infarction; Polylactic acid; Polymers; Thrombosis
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.28290

Objective This meta‐analysis sought to evaluate the outcomes of absorb bioresorbable vascular scaffolds (BVS) compared with second‐generation drug‐eluting stents (DES) after 3 years, the approximate time of complete polymer bioresorption. Background BVS were found to be inferior to second‐generation DES in early and mid‐term outcomes with a higher rate of target vessel myocardial infarction (TV‐MI) and device thrombosis (DT). Improper implantation techniques and incomplete bioresorption of the poly‐l‐lactide (PLLA) polymer were sighted as possible reasons. Methods We conducted an electronic database search for all randomized control trials that compared absorb BVS to second‐generation DES and reported outcomes of interest after 3 years of absorb BVS implantation. Assuming interstudy heterogeneity, a random‐effects analysis was conducted with odds ratio as the effect size of choice to compare the event rates between the two groups. Results A total of four studies (n = 3,245, BVS = 2075, DES = 1,170) were included in the final analysis. Pooled analysis revealed that there was no difference between absorb BVS and second‐generation DES with respect to target lesion failure (TLF) (OR = 1.23, 95% CI = 0.73–2.07, p = 0.44), TV‐MI (OR = 1.03, 95% CI = 0.42–2.53, p = 0.95), target lesion revascularization (TLR) (OR = 1.61, 95% CI = 0.77–3.33, p = 0.20) and definite/probable DT (OR = 0.71, 95% CI = 0.10–5.07, p = 0.74). Also, there was no difference in cardiac mortality (OR = 0.66, 95% CI = 0.22–1.94, p = 0.45). Conclusions Between 3 and 4 years of follow‐up, patients receiving absorb BVS did not have significantly different outcomes, in terms of TLF, TV‐MI, TLR, DT, and cardiac mortality, compared to DES.