Use of bioresorbable vascular scaffold: a meta-analysis of patients with coronary artery disease.
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.



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.



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).



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.
Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, UK; Postgraduate Medical School, University of Hertfordshire, Hertfordshire, UK.
Mohamed
M
Farag
Department of Cardiology , East and North Hertfordshire NHS Trust , Hertfordshire , UK.
Nikolaos
N
Spinthakis
Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, UK; Postgraduate Medical School, University of Hertfordshire, Hertfordshire, UK; National Heart & Lung Institute, Imperial College, London, UK.
Diana A
DA
Gorog
St George's , University of London, London , UK.
Abhiram
A
Prasad
Postgraduate Medical School, University of Hertfordshire , Hertfordshire , UK.
Keith
K
Sullivan
Department of Cardiology , East and North Hertfordshire NHS Trust , Hertfordshire , UK.
Zaki
Z
Akhtar
Department of Cardiology , East and North Hertfordshire NHS Trust , Hertfordshire , UK.
Neville
N
Kukreja
Department of Cardiology , East and North Hertfordshire NHS Trust , Hertfordshire , UK.
Manivannan
M
Srinivasan
CORONARY ARTERY DISEASE; bioresorbable scaffold; drug-eluting stent; percutaneous coronary intervention