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Scaffold Thrombosis After PCI With ABSORB BVS
Study Questions:
What is the risk of stent scaffold thrombosis (ST) in patients undergoing percutaneous coronary intervention (PCI) with ABSORB bioresorbable vascular scaffold (BVS)?
Methods:
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).
Results:
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).
Conclusions:
Patients undergoing PCI with a BVS had increased definite/probable ST and MI during follow-up compared with DES.
Perspective:
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.
Keywords: Drug-Eluting Stents, Myocardial Infarction, Percutaneous Coronary Intervention, Risk, Stents, Thrombosis
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