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Original research article
Use of bioresorbable vascular scaffold: a meta-analysis of patients with coronary artery disease
  1. Mohamed Farag1,2,
  2. Nikolaos Spinthakis1,
  3. Diana A Gorog1,2,3,
  4. Abhiram Prasad4,
  5. Keith Sullivan2,
  6. Zaki Akhtar1,
  7. Neville Kukreja1 and
  8. Manivannan Srinivasan1
  1. 1Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, UK
  2. 2Postgraduate Medical School, University of Hertfordshire, Hertfordshire, UK
  3. 3National Heart & Lung Institute, Imperial College, London, UK
  4. 4St George's, University of London, London, UK
  1. Correspondence to Dr Manivannan Srinivasan; manivannan.srinivasan{at}nhs.net

Abstract

Background Differences in outcomes between bioresorbable vascular scaffold (BVS) systems and drug-eluting metal stents (DES) have not been fully evaluated. We aimed to compare clinical and angiographic outcomes in randomised studies of patients with coronary artery disease (CAD), with a secondary analysis performed among registry studies.

Methods A meta-analysis comparing outcomes between BVS and DES in patients with CAD. Overall estimates of treatment effect were calculated with random-effects model and fixed-effects model.

Results In 6 randomised trials (3818 patients), BVS increased the risk of subacute stent thrombosis (ST) over and above DES (OR 2.14; CI 1.01 to 4.53; p=0.05), with a trend towards an increase in the risk of myocardial infarction (MI) (125 events in those assigned to BVS and 50 to DES; OR 1.36; CI 0.97 to 1.91; p=0.07). The risk of in-device late lumen loss (LLL) was higher with BVS than DES (mean difference 0.08 mm; CI 0.03 to 0.13; p=0.004). There was no difference in the risk of death or target vessel revascularisation (TVR) between the two devices. In 6 registry studies (1845 patients), there was no difference in the risk of death, MI, TVR or subacute ST between the two stents. Final BVS dilation pressures were higher in registry than in randomised studies (18.7±4.6 vs 15.2±3.3 atm; p<0.001).

Conclusions Patients treated with BVS had an increased risk of subacute ST and slightly higher LLL compared with those with DES, but this might be related to inadequate implantation techniques, in particular device underexpansion.

  • bioresorbable scaffold
  • drug-eluting stent
  • CORONARY ARTERY DISEASE
  • percutaneous coronary intervention

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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