Comparison Between Bare-Metal Stents, First-Generation Drug-Eluting Stents, and Bioresorbable Vascular Scaffolds

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Biomaterials Science

Background:

• Long-term clinical outcomes of bioresorbable vascular scaffolds (BVS) are less understood compared to drug-eluting stents (DES).
• Comparisons of BVS have primarily focused on second-generation DES, not earlier stent types like bare-metal stents (BMS) or first-generation DES.

Purpose of the Study:

• To compare major adverse cardiovascular event (MACE) rates at 3 years following implantation of BVS, first-generation DES, and BMS.
• To evaluate the safety and efficacy of BVS against historical stent technologies.

Main Methods:

• A single-center observational study utilizing a percutaneous coronary intervention (PCI) registry.
• Primary endpoint: MACE at 3 years (composite of death, myocardial infarction, target-vessel revascularization).
• Comparison of 170 patients with everolimus-eluting BVS against 622 patients with BMS and 604 patients with first-generation DES.

Main Results:

• Adjusted analysis revealed a significantly lower MACE risk for DES compared to BMS (OR, 0.58; P<.01).
• BVS demonstrated similar MACE risk compared to BMS (OR, 0.91; P=.72) and first-generation DES (OR, 1.45; P=.19) at 3 years.
• No significant difference in MACE rates was observed between BVS and either BMS or first-generation DES.

Conclusions:

• Bioresorbable vascular scaffold (BVS) implantation in PCI patients did not result in a significantly different risk of 3-year MACE compared to BMS or first-generation DES.
• These findings contribute to understanding the long-term performance of BVS relative to established stent technologies.
• Further research may be warranted to elucidate specific patient populations or lesion characteristics where BVS may offer distinct advantages or disadvantages.