Scaffold Thrombosis After PCI With ABSORB BVS
What is the risk of stent scaffold thrombosis (ST) in patients undergoing percutaneous coronary intervention (PCI) with ABSORB bioresorbable vascular scaffold (BVS)?
The authors performed a meta-analysis and a systematic review of studies assessing risk of ST after BVS implantation. Random-effects models were used to generate pooled estimates of outcome for studies comparing BVS with drug-eluting stents (DES).
The analysis included 25 studies of 10,510 patients (8,351 with a BVS and 2,159 with DES) with a follow-up of 6.4 ± 5.1 months. Among patients with a BVS, cardiovascular death occurred in 0.6%, 0.27% had acute ST, and 0.57% had subacute ST, whereas myocardial infarction (MI) occurred in 2.1% and target lesion revascularization was performed in 2.0%. Nine studies were included in a meta-analysis (1,948 patients received a BVS and 2,150 patients DES). Patients who received a BVS were at a higher risk of MI (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.31-3.22; p = 0.002) and definite/probable ST (OR, 2.06; 95% CI, 1.07-3.98; p = 0.03) compared with patients who received DES, whereas there was a trend toward decreased all-cause mortality with a BVS (OR, 0.40; 95% CI, 0.15-1.06; p = 0.06).
Patients undergoing PCI with a BVS had increased definite/probable ST and MI during follow-up compared with DES.
This study provides a nice overview of the comparative safety of BVS and second-generation DES, and highlights the remarkable increase in risk of ST with BVS. Multiple observational studies as well as a smaller body of randomized data have highlighted the increased risk of ST with BVS, and adequately powered trials are needed to assess the long-term safety and efficacy of BVS before it can be incorporated into routine clinical practice.
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