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5-Year Outcomes After Bioresorbable Coronary Scaffolds Implanted With Improved Technique
Gregg W Stone1, Dean J Kereiakes2, Tommaso Gori3
1Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Journal of the American College of Cardiology
|May 19, 2023
Summary
Bioresorbable vascular scaffolds (BVS) showed a higher rate of target lesion failure compared to cobalt-chromium everolimus-eluting stents (CoCr-EES) at five years. However, event rates were similar after three years, coinciding with scaffold bioresorption.
Area of Science:
- Cardiovascular Medicine
- Biomaterials Science
- Interventional Cardiology
Background:
- Bioresorbable vascular scaffolds (BVS) aimed to reduce late adverse events compared to metallic drug-eluting stents.
- Early BVS trials indicated poorer outcomes, partly due to implantation technique.
- The ABSORB IV trial investigated polymeric everolimus-eluting BVS with improved technique against cobalt-chromium everolimus-eluting stents (CoCr-EES).
Purpose of the Study:
- To assess the long-term efficacy and safety of bioresorbable vascular scaffolds (BVS).
- To compare five-year outcomes of BVS with improved technique versus traditional metallic stents.
Main Methods:
- A large-scale, blinded, randomized trial involving 2,604 patients with coronary syndromes.
- Patients were randomized to receive either BVS with improved technique or CoCr-EES.
- Five-year follow-up data was collected and analyzed.
Main Results:
- Target lesion failure occurred in 17.5% of BVS patients versus 14.5% of CoCr-EES patients at five years (P=0.03).
- Device thrombosis rates were 1.7% for BVS and 1.1% for CoCr-EES (P=0.15).
- Higher event rates for BVS were observed up to three years, with similar rates thereafter; angina recurrence was comparable between groups.
Conclusions:
- Despite improved technique, BVS demonstrated a higher absolute five-year target lesion failure rate compared to CoCr-EES.
- The increased risk associated with BVS was confined to the first three years, post-scaffold bioresorption.
- Angina recurrence was frequent but similar for both BVS and CoCr-EES over five years.
