Late thrombotic events after bioresorbable scaffold implantation: a systematic review and meta-analysis of randomized clinical trials

Collet, Carlos; Asano, Taku; Miyazaki, Yosuke; Tenekecioglu, Erhan; Katagiri, Yuki; Sotomi, Yohei; Cavalcante, Rafael; Winter, Robbert J. de; Kimura, Takeshi; Gao, Runlin; Puricel, Serban; Cook, Stéphane; Capodanno, Davide; Onuma, Yoshinobu; Serruys, Patrick W.

doi:10.1093/eurheartj/ehx155

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Journal article

Late thrombotic events after bioresorbable scaffold implantation: a systematic review and meta-analysis of randomized clinical trials

Collet, Carlos Department of Cardiology, Academic Medical Center, Universiteit van Amsterdam, Netherlands
Asano, Taku Department of Cardiology, Academic Medical Center, Universiteit van Amsterdam, Netherlands
Miyazaki, Yosuke Department of Interventional Cardiology, Rotterdam, Netherlands
Tenekecioglu, Erhan Department of Interventional Cardiology, Rotterdam, Netherlands
Katagiri, Yuki Department of Cardiology, Academic Medical Center, Universiteit van Amsterdam, Netherlands
Sotomi, Yohei Department of Cardiology, Academic Medical Center, Universiteit van Amsterdam, Netherlands
Cavalcante, Rafael Department of Interventional Cardiology, Rotterdam, Netherlands
Winter, Robbert J. de Department of Cardiology, Academic Medical Center, Universiteit van Amsterdam, Netherlands
Kimura, Takeshi Department of Cardiovascular Medicine, Kyoto University Hospital, Shogoin Kawaharacho, Sakyo Ward, Kyoto, Japan
Gao, Runlin Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
Puricel, Serban Department of Cardiology, University of Fribourg and Hospital, Fribourg, Switzerland
Cook, Stéphane Department of Cardiology, University of Fribourg and Hospital, Fribourg, Switzerland
Capodanno, Davide Cardio-Thoracic-Vascular Department, Ferrarotto Hospital, University of Catania, Italy
Onuma, Yoshinobu Department of Interventional Cardiology, Rotterdam, Netherlands
Serruys, Patrick W. Imperial Department of Medicine, Imperial College of London, Kensington, London, UK

2017

Published in:

European Heart Journal. - 2017, vol. 38, no. 33, p. 2559-2566

English 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.

Faculty

Faculté des sciences et de médecine

Department

Médecine 3ème année

Language