Carlos Collet1, Taku Asano1, Yosuke Miyazaki2, Erhan Tenekecioglu2, Yuki Katagiri1, Yohei Sotomi1, Rafael Cavalcante2, Robbert J de Winter1, Takeshi Kimura3, Runlin Gao4, Serban Puricel5, Stéphane Cook5, Davide Capodanno6, Yoshinobu Onuma2, Patrick W Serruys7. 1. Department of Cardiology, Academic Medical Center, Universiteit van Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam-Zuidoost, Netherlands. 2. Department of Interventional Cardiology, 's-Gravendijkwal 230, 3015 CE Rotterdam, Netherlands. 3. Department of Cardiovascular Medicine, Kyoto University Hospital, Shogoin Kawaharacho, Sakyo Ward, Kyoto, Kyoto Prefecture 606-8507, Japan. 4. Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, 10 Beijing, China. 5. Department of Cardiology, Fribourg University and Hospital, Avenue de l'Europe 20, 1700 Fribourg, Switzerland. 6. Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Via Salvatore Citelli, 6, 95124 Catania CT, Italy. 7. Imperial Department of Medicine, Imperial College of London, Kensington, London SW7 2AZ, UK.
Abstract
AIMS: To compare the long-term safety and efficacy of bioresorbable vascular scaffold (BVS) with everolimus-eluting stent (EES) after percutaneous coronary interventions. METHODS AND RESULTS: A systematic review and meta-analysis of randomized clinical trials comparing clinical outcomes of patients treated with BVS and EES with at least 24 months follow-up was performed. Adjusted random-effect model by the Knapp-Hartung method was used to compute odds ratios (OR) and 95% confidence intervals (CI). The primary safety outcome of interest was the risk of definite/probable device thrombosis (DT). The primary efficacy outcome of interest was the risk of target lesion failure (TLF). Five randomized clinical trials (n = 1730) were included. Patients treated with Absorb BVS had a higher risk of definite/probable DT compared with patients treated with EES (OR 2.93, 95%CI 1.37-6.26, P = 0.01). Very late DT (VLDT) occurred in 13 patients [12/996 (1.4%, 95%CI: 0.08-2.5) Absorb BVS vs. 1/701 (0.5%, 95%CI: 0.2-1.6) EES; OR 3.04; 95%CI 1.2-7.68, P = 0.03], 92% of the VLDT in the BVS group occurred in the absence of dual antiplatelet therapy (DAPT). Patients treated with Absorb BVS had a trend towards higher risk of TLF (OR 1.48, 95%CI 0.90-2.42, P = 0.09), driven by a higher risk of target vessel myocardial infarction and ischaemia-driven target lesion revascularization. No difference was found in the risk of cardiac death. CONCLUSION: Compared with EES, the use of Absorb BVS was associated with a higher rate of DT and a trend towards higher risk of TLF. VLDT occurred in 1.4% of the patients, the majority of these events occurred in the absence of DAPT. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: To compare the long-term safety and efficacy of bioresorbable vascular scaffold (BVS) with everolimus-eluting stent (EES) after percutaneous coronary interventions. METHODS AND RESULTS: A systematic review and meta-analysis of randomized clinical trials comparing clinical outcomes of patients treated with BVS and EES with at least 24 months follow-up was performed. Adjusted random-effect model by the Knapp-Hartung method was used to compute odds ratios (OR) and 95% confidence intervals (CI). The primary safety outcome of interest was the risk of definite/probable device thrombosis (DT). The primary efficacy outcome of interest was the risk of target lesion failure (TLF). Five randomized clinical trials (n = 1730) were included. Patients treated with Absorb BVS had a higher risk of definite/probable DT compared with patients treated with EES (OR 2.93, 95%CI 1.37-6.26, P = 0.01). Very late DT (VLDT) occurred in 13 patients [12/996 (1.4%, 95%CI: 0.08-2.5) Absorb BVS vs. 1/701 (0.5%, 95%CI: 0.2-1.6) EES; OR 3.04; 95%CI 1.2-7.68, P = 0.03], 92% of the VLDT in the BVS group occurred in the absence of dual antiplatelet therapy (DAPT). Patients treated with Absorb BVS had a trend towards higher risk of TLF (OR 1.48, 95%CI 0.90-2.42, P = 0.09), driven by a higher risk of target vessel myocardial infarction and ischaemia-driven target lesion revascularization. No difference was found in the risk of cardiac death. CONCLUSION: Compared with EES, the use of Absorb BVS was associated with a higher rate of DT and a trend towards higher risk of TLF. VLDT occurred in 1.4% of the patients, the majority of these events occurred in the absence of DAPT. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: T M Hommels; R S Hermanides; S Rasoul; B Berta; A J J IJsselmuiden; G A J Jessurun; E Benit; B Pereira; G De Luca; E Kedhi Journal: Cardiovasc Diabetol Date: 2019-03-09 Impact factor: 9.951
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