Stent Thrombosis With DES and Bioresorbable Scaffolds

Study Questions:

What is the relative safety and efficacy of contemporary drug-eluting stents (DES) and bioresorbable vascular scaffolds (BVS)?

Methods:

Prospective, randomized, controlled trials comparing bare-metal stents (BMS), paclitaxel-eluting stents (PES), sirolimus-eluting stents (SES), Endeavor zotarolimus-eluting stents (E-ZES), cobalt-chromium (CoCr) everolimus-eluting stents (EES), platinum-chromium (PtCr)-EES, biodegradable polymer (BP)-EES, Resolute zotarolimus-eluting stents (R-ZES), BP biolimus-eluting stents (BP-BES), hybrid sirolimus-eluting stents (H [Orsiro]-SES), polymer-free sirolimus- and probucol-eluting stents, or BVS were searched in online databases. The primary endpoint was definite or probable stent thrombosis at 1 year. A Bayesian random-effects model for multiple treatment comparisons was constructed to compare clinical outcomes of different stent types.

Results:

A total of 147 trials including 126,526 patients were analyzed in this study. All contemporary DES were superior to BMS and PES in terms of definite or probable stent thrombosis at 1 year. CoCr-EES, PtCr-EES, and H-SES were associated with significantly lower risk than BVS. CoCr-EES and H-SES were superior to SES and BP-BES. The risk of myocardial infarction was significantly lower with H-SES than with BVS. There were no significant differences regarding all-cause or cardiac mortality. Contemporary devices including BVS showed comparably low risks of repeat revascularization.

Conclusions:

The authors concluded that contemporary DES, including biocompatible DP-DES, BP-DES, and polymer-free DES, showed a low risk of definite or probable stent thrombosis at 1 year.

Perspective:

This meta-analysis reports that contemporary DES, including second-generation biocompatible DP-DES, BP-DES, and polymer-free DES, showed excellent safety profiles in terms of definite or probable ST at 1 year. In contrast, BVS were associated with significantly increased risk of device thrombosis compared with CoCr-EES, PtCr-EES, and H-SES. Extended follow-up of ongoing clinical trials would provide additional insight on the safety of these BVS devices.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Stable Ischemic Heart Disease, Cardiac Surgery and SIHD, Chronic Angina

Keywords: Chromium, Cobalt, Coronary Restenosis, Drug-Eluting Stents, Myocardial Infarction, Myocardial Revascularization, Paclitaxel, Platinum, Polymers, Probucol, Sirolimus, Stents, Thrombosis


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