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Lee JM, Joh HS, Choi KH, Hong D, Park TK, Yang JH, Song YB, Choi JH, Choi SH, Jeong JO, Lee JY, Choi YJ, Chae JK, Hur SH, Bae JW, Oh JH, Chun KJ, Kim HJ, Cho BR, Shin D, Lee SH, Hwang D, Lee HJ, Jang HJ, Kim HK, Ha SJ, Shin ES, Doh JH, Hahn JY, Gwon HC. Safety and Efficacy of Everolimus-Eluting Bioresorbable Vascular Scaffold Versus Second-Generation Drug-Eluting Stents in Real-World Practice. J Korean Med Sci 2023; 38:e34. [PMID: 36747363 PMCID: PMC9902667 DOI: 10.3346/jkms.2023.38.e34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 10/27/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The risk of device thrombosis and device-oriented clinical outcomes with bioresorbable vascular scaffold (BVS) was reported to be significantly higher than with contemporary drug-eluting stents (DESs). However, optimal device implantation may improve clinical outcomes in patients receiving BVS. The current study evaluated mid-term safety and efficacy of Absorb BVS with meticulous device optimization under intravascular imaging guidance. METHODS The SMART-REWARD and PERSPECTIVE-PCI registries in Korea prospectively enrolled 390 patients with BVS and 675 patients with DES, respectively. The primary endpoint was target vessel failure (TVF) at 2 years and the secondary major endpoint was patient-oriented composite outcome (POCO) at 2 years. RESULTS Patient-level pooled analysis evaluated 1,003 patients (377 patients with BVS and 626 patients with DES). Mean scaffold diameter per lesion was 3.24 ± 0.30 mm in BVS group. Most BVSs were implanted with pre-dilatation (90.9%), intravascular imaging guidance (74.9%), and post-dilatation (73.1%) at proximal to mid segment (81.9%) in target vessel. Patients treated with BVS showed comparable risks of 2-year TVF (2.9% vs. 3.7%, adjusted hazard ratio [HR], 1.283, 95% confidence interval [CI], 0.487-3.378, P = 0.615) and 2-year POCO (4.5% vs. 5.9%, adjusted HR, 1.413, 95% CI, 0.663-3.012, P = 0.370) than those with DES. The rate of 2-year definite or probable device thrombosis (0.3% vs. 0.5%, P = 0.424) was also similar. The sensitivity analyses consistently showed comparable risk of TVF and POCO between the 2 groups. CONCLUSION With meticulous device optimization under imaging guidance and avoidance of implantation in small vessels, BVS showed comparable risks of 2-year TVF and device thrombosis with DES. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02601404, NCT04265443.
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Affiliation(s)
- Joo Myung Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Sung Joh
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki Hong Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - David Hong
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Ho Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jong-Young Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Jin Choi
- Division of Cardiology, Department of Internal Medicine, Bucheon Sejong Hospital, Bucheon, Korea
| | - Jei-Keon Chae
- Division of Cardiology, Department of Internal Medicine, Jeonbuk National University Hospital and Jeonbuk National University Medical School, Jeonju, Korea
| | - Seung-Ho Hur
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Jang-Whan Bae
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University, Cheongju, Korea
| | - Ju-Hyeon Oh
- Division of Cardiology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Kook-Jin Chun
- Department of Cardiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyun-Joong Kim
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Byung Ryul Cho
- Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Doosup Shin
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Hyun-Jong Lee
- Division of Cardiology, Department of Internal Medicine, Bucheon Sejong Hospital, Bucheon, Korea
| | - Ho-Jun Jang
- Division of Cardiology, Department of Internal Medicine, Bucheon Sejong Hospital, Bucheon, Korea
| | - Hyun Kuk Kim
- Department of Internal Medicine and Cardiovascular Center, Chosun University Hospital, University of Chosun College of Medicine, Gwangju, Korea
| | - Sang Jin Ha
- Division of Cardiology, Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Eun-Seok Shin
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Joon-Hyung Doh
- Department of Cardiology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Yin J, Li Y, Chen Y, Wang C, Song X. Biodegradable polymer everolimus-eluting stents versus contemporary drug-eluting stents: a systematic review and meta‑analysis. Sci Rep 2023; 13:1715. [PMID: 36720978 PMCID: PMC9889391 DOI: 10.1038/s41598-022-26654-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 12/19/2022] [Indexed: 02/01/2023] Open
Abstract
In spite of similar efficacy and safety in pilot studies, compared with the contemporary durable polymer drug-eluting stent (DP-DES), the bioabsorbable polymer drug-eluting stent (BP-DES) may be more superior in promoting blood vessel healing. We sought to compare the safety and efficacy of everolimus-eluting BP-DES (BP-EES) with contemporary DP-DES through a meta-analysis. We performed this meta-analysis to provide further evidence of the safety and efficacy of BP-EES. Medline, Embase and the Cochrane library databases were searched for randomized controlled trials comparing clinical efficacy and safety of BP-EES versus contemporary DP-DES. Fifteen RCTs with a total of 15,572 patients were selected. The rate of MACE was 9.4% in patients receiving BP-EES and 7.3% receiving DP-EES (RR 1.13, 95% CI 0.99-1.29, p = 0.05; I2 = 46%). TLF and MI were also similar in both groups. Based on the available data, this review demonstrates that BP-EES displays a clinically comparable efficacy and safety profile to that of contemporary DP-DES at years of follow-up in patients undergoing PCI.
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Affiliation(s)
- Juntao Yin
- Department of Pharmacy, Huaihe Hospital, Henan University, Kaifeng, China
| | - Yang Li
- Department of Pharmacy, Huaihe Hospital, Henan University, Kaifeng, China
| | - Yangyang Chen
- Department of Cardiology, Huaihe Hospital, Henan University, Kaifeng, Henan, China
| | - Chaoyang Wang
- Department of General Surgery, Huaihe Hospital, Henan University, Kaifeng, Henan, China. .,Evidence-Based Medicine Center, Department of Medicine, Henan University, Kaifeng, 475000, Henan, China.
| | - Xiaoyong Song
- Department of Pharmaceutics, School of Pharmacy, Henan University, Kaifeng, 475000, Henan, China.
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Jackson-Smith E, Zioupos S, Banerjee P. Bioresorbable vascular scaffolds versus conventional drug-eluting stents across time: a meta-analysis of randomised controlled trials. Open Heart 2022; 9:e002107. [PMID: 36288820 PMCID: PMC9615997 DOI: 10.1136/openhrt-2022-002107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 09/12/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Bioresorbable vascular scaffolds (BVS) were designed to reduce the rate of late adverse events observed in conventional drug-eluting stents (DES) by dissolving once they have restored lasting patency. OBJECTIVES Compare the safety and efficacy of BVS versus DES in patients receiving percutaneous coronary intervention for coronary artery disease across a complete range of randomised controlled trial (RCT) follow-up intervals. METHODS A systematic review and meta-analysis was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, EMBASE and Web of Science were searched from inception through 5 January 2022 for RCTs comparing the clinical outcomes of BVS versus DES. The primary safety outcome was stent/scaffold thrombosis (ST), and the primary efficacy outcome was target lesion failure (TLF: composite of cardiac death, target vessel myocardial infarction (TVMI) and ischaemia-driven target lesion revascularisation (ID-TLR)). Secondary outcomes were patient-oriented composite endpoint (combining all-death, all-MI and all-revascularisation), its individual components and those of TLF. Studies were appraised using Cochrane's Risk of Bias tool and meta-analysis was performed using RevMan V.5.4. RESULTS 11 919 patients were randomised to receive either BVS (n=6438) or DES (n=5481) across 17 trials (differing follow-up intervals from 3 months to 5 years). BVS demonstrated increased risk of ST across all timepoints (peaking at 2 years with risk ratio (RR): 3.47; 95% CI 1.80 to 6.70; p=0.0002). Similarly, they showed increased risk of TLF (peaking at 3 years, RR: 1.35; 95% CI 1.07 to 1.70; p=0.01) resulting from high rates of TVMI and ID-TLR. Though improvements were observed after device dissolution (5-year follow-up), these were non-significant. All other outcomes were statistically equivalent. Applicability to all BVS is limited by 91% of the BVS group receiving Abbott's Absorb. CONCLUSION This meta-analysis demonstrates that current BVS are inferior to contemporary DES throughout the first 5 years at minimum.
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Affiliation(s)
| | | | - Prithwish Banerjee
- Warwick Medical School, University of Warwick, Coventry, UK
- Centre for Sports, Exercise & Life Sciences (CSELS), Coventry University Faculty of Health and Life Sciences, Coventry, UK
- Department of Cardiology, University Hospitals Coventry and Warwickshire, Coventry, UK
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Sustained safety and efficacy of magnesium reabsorbable scaffold. 2-year follow-up analysis from first Magmaris multicenter Italian registry. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 41:69-75. [DOI: 10.1016/j.carrev.2022.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 11/23/2022]
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Yin T, Du R, Wang Y, Huang J, Ge S, Huang Y, Tan Y, Liu Q, Chen Z, Feng H, Du J, Wang Y, Wang G. Two-stage degradation and novel functional endothelium characteristics of a 3-D printed bioresorbable scaffold. Bioact Mater 2021; 10:378-396. [PMID: 34901554 PMCID: PMC8636822 DOI: 10.1016/j.bioactmat.2021.08.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 12/13/2022] Open
Abstract
Bioresorbable scaffolds have emerged as a new generation of vascular implants for the treatment of atherosclerosis, and designed to provide a temporary scaffold that is subsequently absorbed by blood vessels over time. Presently, there is insufficient data on the biological and mechanical responses of blood vessels accompanied by bioresorbable scaffolds (BRS) degradation. Therefore, it is necessary to investigate the inflexion point of degradation, the response of blood vessels, and the pathophysiological process of vascular, as results of such studies will be of great value for the design of next generation of BRS. In this study, abdominal aortas of SD rats were received 3-D printed poly-l-actide vascular scaffolds (PLS) for various durations up to 12 months. The response of PLS implanted aorta went through two distinct processes: (1) the neointima with desirable barrier function was obtained in 1 month, accompanied with slow degradation, inflammation, and intimal hyperplasia; (2) significant degradation occurred from 6 months, accompanied with decreasing inflammation and intimal hyperplasia, while the extracellular matrix recovered to normal vessels which indicate the positive remodeling. These in vivo results indicate that 6 months is a key turning point. This “two-stage degradation and vascular characteristics” is proposed to elucidate the long-term effects of PLS on vascular repair and demonstrated the potential of PLS in promoting endothelium function and positive remodeling, which highlights the benefits of PLS and shed some light in the future researches, such as drug combination coatings design. Proposed two-stage degradation of a PLLA BRS to reveal distinct neointimal recovery and vascular responsive processes. Revealed novel benefits of BRS, including fine endothelium function, anti-thrombosis, and anti-inflammatory. Drug combination coatings should be designed concerning special degradation of BRS and the key turning point, 6 months.
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Affiliation(s)
- Tieying Yin
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China
| | - Ruolin Du
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China
| | - Yang Wang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China
| | - Junyang Huang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China
| | - Shuang Ge
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China
| | - Yuhua Huang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China
| | - Youhua Tan
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Qing Liu
- Beijing Advanced Medical Technologies Inc., Beijing, 102609, China
| | - Zhong Chen
- Beijing Anzhen Hospital of Capital Medical University, Beijing, 100029, China
| | - Hanqing Feng
- Beijing Advanced Medical Technologies Inc., Beijing, 102609, China
| | - Jie Du
- Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Ave, Beijing, 10029, China
| | - Yazhou Wang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China.,School of Medicine, Chongqing University, Chongqing, 400044, China
| | - Guixue Wang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China
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Boeder NF, Kastner J, Mehilli J, Münzel T, Naber C, Neumann T, Richardt G, Schmermund A, Wöhrle J, Zahn R, Riemer T, Achenbach S, Hamm CW, Nef HM. Predictors of scaffold failure and impact of optimized scaffold implantation technique on outcome: Results from the German-Austrian ABSORB RegIstRy. Catheter Cardiovasc Interv 2021; 98:E555-E563. [PMID: 34143547 DOI: 10.1002/ccd.29829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/28/2021] [Accepted: 06/05/2021] [Indexed: 11/05/2022]
Abstract
AIMS We aimed to investigate predictors of scaffold failure and the potential impact of an optimized scaffold implantation technique by means of a learning curve on long-term clinical outcome after bioresorbable scaffold (BRS) implantation and to evaluate predictors of scaffold failure. METHODS AND RESULTS A total of 3326 patients were included in this prospective, observational, multi-center study (ClinicalTrials.gov NCT02066623) of consecutive patients undergoing BRS implantation between November 2013 and January 2016. The 3144 patients completed follow-up after 24 months, 3265 patients were eligible for time-to-event-analysis. Clinical endpoints were major adverse cardiac events-a composite endpoint of death, target vessel revascularization and myocardial infarction, and scaffold thrombosis (ScT). Patients were grouped according to treatment before or since 2015. During follow-up MACE rate improved from 2.52% after 30 days, 5.45% after 6 months and 12.67% after 24 months to 1.52%, 3.44%, and 10.52%, respectively. A total of 75 ScT occurred. In multiple regression analysis, treatment of bifurcations, long lesions, and procedures performed earlier than 2014 were identified as predictors for the occurrence of ScT. CONCLUSION Treatment of bifurcation lesions is the strongest predictor of ScT following BRS implantation. A significantly lower incidence of ScT and 24-month target lesion revascularization in patients recruited after 2014 into our observational registry suggests the influence of a learning curve.
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Affiliation(s)
- Niklas F Boeder
- Department of Cardiology, University of Giessen, Giessen, Germany
| | - Johannes Kastner
- Department of Cardiology, University of Vienna Medical School, Vienna, Austria
| | - Julinda Mehilli
- Department of Cardiology, Krankenhaus Landshut-Achendorf, Landshut, Germany
| | - Thomas Münzel
- Department of Medicine II, University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Christoph Naber
- Department of Cardiology, Klinikum Wilhelmshaven, Wilhelmshaven, Germany
| | | | - Gert Richardt
- Division of Cardiology, Herzzentrum, Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | - Axel Schmermund
- Division of Cardiology, Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany
| | - Jochen Wöhrle
- Department of Cardiology, Medizin Campus Bodensee, Friedrichshafen, Germany
| | - Ralf Zahn
- Department of Cardiology, Herzzentrum Ludwigshafen, Ludwigshafen, Germany
| | - Thomas Riemer
- IHF GmbH - Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Christian W Hamm
- Department of Cardiology, University of Giessen, Giessen, Germany
| | - Holger M Nef
- Department of Cardiology, University of Giessen, Giessen, Germany
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Recent advances and directions in the development of bioresorbable metallic cardiovascular stents: Insights from recent human and in vivo studies. Acta Biomater 2021; 127:1-23. [PMID: 33823325 DOI: 10.1016/j.actbio.2021.03.058] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 12/12/2022]
Abstract
Over the past two decades, significant advancements have been made regarding the material formulation, iterative design, and clinical translation of metallic bioresorbable stents. Currently, magnesium-based (Mg) stent devices have remained at the forefront of bioresorbable stent material development and use. Despite substantial advances, the process of developing novel absorbable stents and their clinical translation is time-consuming, expensive, and challenging. These challenges, coupled with the continuous refinement of alternative bioresorbable metallic bulk materials such as iron (Fe) and zinc (Zn), have intensified the search for an ideal absorbable metallic stent material. Here, we discuss the most recent pre-clinical and clinical evidence for the efficacy of bioresorbable metallic stents and material candidates. From this perspective, strategies to improve the clinical performance of bioresorbable metallic stents are considered and critically discussed, spanning material alloy development, surface manipulations, material processing techniques, and preclinical/biological testing considerations. STATEMENT OF SIGNIFICANCE: Recent efforts in using Mg, Fe, and Zn based materials for bioresorbable stents include elemental profile changes as well as surface modifications to improve each of the three classes of materials. Although a variety of alloys for absorbable metallic stents have been developed, the ideal absorbable stent material has not yet been discovered. This review focuses on the state of the art for bioresorbable metallic stent development. It covers the three bulk materials used for degradable stents (Mg, Fe, and Zn), and discusses their advances from a translational perspective. Strategies to improve the clinical performance of bioresorbable metallic stents are considered and critically discussed, spanning material alloy development, surface manipulations, material processing techniques, and preclinical/biological testing considerations.
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Elwany M, Zaki A, Latib A, Testa L, Ielasi A, Piraino D, Geraci S, El Zawawy T, Cortese B. The impact of the use of bioresorbable vascular scaffolds and drug-coated balloons in coronary bifurcation lesions. Egypt Heart J 2019; 71:31. [PMID: 31845098 PMCID: PMC6914751 DOI: 10.1186/s43044-019-0033-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/19/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the improvement in techniques and tools, coronary lesions involving a bifurcation are still challenging and the outcome with drug-eluting stents is not always optimal. The role of bioresorbable vascular scaffolds (BVS) and drug-coated balloons (DCB) in this setting has not been adequately investigated yet. RESULTS From the databases of 6 italian centers with high proficiencies in newer technologies, we retrospectively collected all consecutive cases of coronary bifurcations managed or attempted with the implantation of at least one BVS in the main vessel and the use of one DCB in the side branch (SB). Primary study endpoint was the occurrence of major adverse cardiovascular events (MACE) at the longest available follow-up. Fourty patients fulfilled the enrollment criterion, 22.5% had diabetes and 50% an acute coronary syndrome. Average syntax score was 15.04 ± 7.18, all lesions were de novo, and 27 patients (67.5%) had a type 1,1,1 Medina lesion. Twenty-three lesions (57.5%) involved the proximal left anterior-descending artery/first diagonal branch. Only 32.5% of patients underwent an intravascular imaging-guided angioplasty. Average lesion length was 21.4 mm in the main vessel and 11.49 mm in the SB. MV was always predilated and BVS received a postdilation in 100% of the cases. In 42.5% of the cases, the DCB was used during final kissing balloon inflation, and in no cases, a stent/BVS was required in the SB. Procedural success was achieved in 100% of the cases. After an average follow-up of 15.5 (± 11.5) months, we observed no MACE with only one case of target vessel revasularization (2.5%). CONCLUSIONS Management of coronary bifurcation lesions with the use of newer technologies including BVS and DCB seems feasible and effective at mid-term and long-term clinical follow-up.
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Affiliation(s)
- Mostafa Elwany
- Interventional Cardiology, San Carlo Clinic, Milano, Italy
- Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Amr Zaki
- Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | | | | | | | | | | | - Tarek El Zawawy
- Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Bernardo Cortese
- Interventional Cardiology, San Carlo Clinic, Milano, Italy
- Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Massa, Italy
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Seth A, Onuma Y, Chandra P, Bahl VK, Manjunath CN, Mahajan AU, Kumar V, Goel PK, Wander GS, Kaul U, Ajit Kumar VK, Abizaid A, Serruys PW. Three-year clinical and two-year multimodality imaging outcomes of a thin-strut sirolimus-eluting bioresorbable vascular scaffold: MeRes-1 trial. EUROINTERVENTION 2019; 15:607-614. [PMID: 31147308 DOI: 10.4244/eij-d-19-00324] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Although the proof of concept of the bioresorbable vascular scaffold (BRS) is well documented, device-related adverse outcomes with first-generation BRS indicate longer-term surveillance. The current study provides insights into the safety and performance of the MeRes100, a novel second-generation sirolimus-eluting BRS, beyond one-year up to three-year follow-up (FU). METHODS AND RESULTS A total of 108 enrolled patients with de novo coronary artery lesions who underwent implantation of MeRes100 as part of the first-in-human MeRes-1 trial were followed up clinically beyond one year at two and three years and with multiple modality imaging at six months and two years. At three-year FU, the cumulative major adverse cardiac events rate was 1.87%, in the form of two ischaemia-driven target lesion revascularisations. No scaffold thrombosis was reported. Between six months and two years at quantitative coronary angiography, in-segment late lumen loss (LLL) (0.15±0.22 mm vs. 0.23±0.32 mm; p=0.18) and in-scaffold LLL (0.13±0.22 mm vs. 0.24±0.34 mm; p=0.10) changed insignificantly. IVUS subset analysis revealed a non-significant reduction in mean lumen area (6.17±1.28 mm2 vs. 5.47±1.50 mm2; p=0.21) and minimum lumen area (5.14±1.19 mm2 vs. 4.05±1.42 mm2; p=0.10) at two years compared to post-procedural measurements. OCT subset analysis demonstrated 99.24±2.27% neointimal strut coverage. CONCLUSIONS The extended outcomes of the MeRes-1 trial demonstrated sustained efficacy and safety of the MeRes100 BRS with maintained lumen patency up to two years by multimodality imaging and no very late scaffold thrombosis up to three-year clinical FU.The MeRes-1 trial is registered at the Clinical Trials Registry-India. CTRI Number: CTRI/2015/04/005706.
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Affiliation(s)
- Ashok Seth
- Fortis Escorts Heart Institute, New Delhi, India
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Lu H, Lee J, Ray S, Tanaka K, Bezerra HG, Rollins AM, Wilson DL. Automated stent coverage analysis in intravascular OCT (IVOCT) image volumes using a support vector machine and mesh growing. BIOMEDICAL OPTICS EXPRESS 2019; 10:2809-2828. [PMID: 31259053 PMCID: PMC6583335 DOI: 10.1364/boe.10.002809] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/22/2019] [Accepted: 05/08/2019] [Indexed: 05/23/2023]
Abstract
Absence of vascular-stent tissue coverage by IVOCT is a biomarker for potential stent-related thrombosis. We developed highly-automated algorithms to classify covered and uncovered struts and quantitatively evaluate stent apposition. We trained a machine learning model on 7,125 images, and included an active learning, relabeling step to improve noisy labels. We obtained uncovered strut classification sensitivity/specificity (94%/90%) comparable to analyst inter-and-intra-observer variability and AUC (0.97), and tissue coverage thickness measurement arguably better than the commercial product. By comparing classification models from regular and relabeled data sets, we observed robustness of the support vector machine to noisy data. A graph-based algorithm detected clusters of uncovered struts thought to pose a greater risk than isolated uncovered struts. The software enables highly-automated, objective, repeatable, comprehensive stent analysis.
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Affiliation(s)
- Hong Lu
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
- Currently located at Microsoft, Azure Global, Cambridge, MA, 02142, USA
| | - Juhwan Lee
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Soumya Ray
- Department of Electrical Engineering & Computer Science, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Kentaro Tanaka
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Hiram G. Bezerra
- Cardiovascular Imaging Core Laboratory, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA
| | - Andrew M. Rollins
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - David L. Wilson
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
- Department of Radiology, Case Western Reserve University, Cleveland, OH, 44106, USA
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Ellis SG, Gori T, Serruys PW, Nef H, Steffenino G, Brugaletta S, Munzel T, Feliz C, Schmidt G, Sabaté M, Onuma Y, van Geuns RJ, Gao RL, Menichelli M, Kereiakes DJ, Stone GW, Testa L, Kimura T, Abizaid A. Clinical, Angiographic, and Procedural Correlates of Very Late Absorb Scaffold Thrombosis: Multistudy Registry Results. JACC Cardiovasc Interv 2019; 11:638-644. [PMID: 29622141 DOI: 10.1016/j.jcin.2017.11.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 11/28/2017] [Accepted: 11/29/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of this study was to identify independent correlates of very late scaffold thrombosis (VLST) from an analysis of consecutively treated patients from 15 multicenter studies. BACKGROUND Recent analyses suggest an increased risk for VLST with the Absorb Bioresorbable Vascular Scaffold compared with drug-eluting stents, but insights as to correlates of risk are limited. METHODS A total of 55 patients were identified with scaffold thrombosis. They were matched 2:1 with control subjects selected randomly from patients without thrombosis from the same study. Quantitative coronary angiography was available for 96.4% of patients. Multiple logistic and Cox regression analysis were used to identify significant independent outcome correlates from 6 pre-specified characteristics. RESULTS Patients had scaffold thrombosis at a median of 20 months (interquartile range: 17 to 27 months). Control subjects were followed for 36 months (interquartile range: 24 to 38 months). For the combined groups, reference vessel diameter (RVD) was 2.84 ± 0.50 mm, scaffold length was 26 ± 16 mm, and post-dilatation was performed in 56%. Univariate correlates of thrombosis were smaller nominal scaffold/RVD ratio (linear p = 0.001; ratio <1.18:1; odds ratio: 7.5; p = 0.002) and larger RVD (linear p = 0.001; >2.72 mm; odds ratio: 3.4; p = 0.001). Post-dilatation at ≥16 atm, post-dilatation balloon/scaffold ratio, final percentage stenosis, and dual antiplatelet therapy were not correlated with VLST. Only scaffold/RVD ratio remained a significant independent correlate of VLST (p = 0.001), as smaller ratio was correlated with RVD (p < 0.001). Post hoc analysis of 8 other potential covariates revealed no other correlates of outcome. CONCLUSIONS In the present analysis, the largest to date of its type, relative scaffold undersizing was the strongest determinant of VLST. Given current understanding of "scaffold dismantling," this finding likely has ramifications for all bioresorbable scaffolds.
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Affiliation(s)
| | - Tommaso Gori
- Kardiologie I, Universitatsmedizin Mainz and DZHK Standort Rhein-Main, Germany
| | - Patrick W Serruys
- Cardiovascular Science Division of the National Heart and Lung Institute (NHLI), Faculty of Medicine, Imperial College, London, United Kingdom
| | - Holger Nef
- UKGM Universitatsklinikum Giessen, Giessen, Germany
| | | | | | - Thomas Munzel
- Kardiologie I, Universitatsmedizin Mainz and DZHK Standort Rhein-Main, Germany
| | - Cordula Feliz
- Cardiovascular Science Division of the National Heart and Lung Institute (NHLI), Faculty of Medicine, Imperial College, London, United Kingdom
| | - Götz Schmidt
- UKGM Universitatsklinikum Giessen, Giessen, Germany
| | - Manel Sabaté
- Hospital Clinic, Institut Clinic Cardiovascular, Barcelona, Spain
| | - Yoshinobu Onuma
- Cardiovascular Science Division of the National Heart and Lung Institute (NHLI), Faculty of Medicine, Imperial College, London, United Kingdom
| | - R J van Geuns
- Cardiovascular Science Division of the National Heart and Lung Institute (NHLI), Faculty of Medicine, Imperial College, London, United Kingdom
| | - Run-Lin Gao
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | | | - Dean J Kereiakes
- The Christ Hospital Heart and Vascular Center and The Lindner Research Center, Cincinnati, Ohio
| | - Gregg W Stone
- Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, New York
| | - Luca Testa
- IRCCS Policlinico San Donato Department of Cardiology, Milan, Italy
| | - Takeshi Kimura
- Department of Cardiovascular Medicine at Kyoto University, Kyoto, Japan
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Zhang H, Zhao J, Xu Y, Zhang W, Sui Y, Liu Q, Wang Y, Liu Z, Gao R, Wu Y. Three-year outcome of everolimus-eluting bioresorbable vascular scaffold versus everolimus-eluting metallic stents: a comprehensive updated meta-analysis of randomized controlled trials. Expert Rev Med Devices 2019; 16:421-427. [PMID: 31008654 DOI: 10.1080/17434440.2019.1610389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION In recent years, everolimus-eluting bioresorbable vascular scaffold stents (EE-BRS) were developed as alternative to everolimus-eluting metallic stents (EES) for coronary artery disease (CAD) treatments. Areas covered: Searches were conducted in MEDLINE, EMBASE, EBSCO, Springer, Ovid, TCTMD, Cardiosource, Clinical Trial Results and the Cochrane Library with combined key words such as bioresorbable vascular scaffold (BVS), everolimus-eluting metallic stents, EES, coronary artery disease, CAD and randomized-Controlled Trials.Finally, 5,474 patients were enrolled for comparison of device-induced thrombosis, ischemia-driven target lesion revascularization (ID-TLR), device-oriented composite endpoints (DOCE), patient-oriented composite endpoints (POCE), and target vessel failure (TVF) between EE-BRS and EES treatments. The primary literature search retrieved 200 records. Expert Opinion: There was no difference regarding DOCEs, POCEs and ID-TLRs for 1 or 2 years, whereas there were significant differences regarding thrombosis between EE-BRS and EES interventions in the 1-year (pooled HR, 2.15, 95%CI: 1.11, 4.18) and 2-year follow-ups (pooled HR, 2.02, 95%CI: 1.08, 3.78), but not in the 3-year follow-up (pooled HR, 1.57, 95%CI: 0.66, 3.75) anymore. The results of this study showed no inferiority of EE-BRS regarding TVF, DOCE, POCE and ID-TLR 1-year and 2-years after interventions, but enhanced risk of thrombosis in the EE-BRS patients, which disappeared in 3-year follow-ups.
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Affiliation(s)
- Hongliang Zhang
- a Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases , Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Jie Zhao
- a Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases , Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Yanlu Xu
- a Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases , Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Wenjia Zhang
- a Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases , Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Yonggang Sui
- a Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases , Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Qingrong Liu
- b School of Basic Medical Sciences , Shanxi Medical University , Taiyuan , Shanxi Province , China
| | - Yubin Wang
- a Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases , Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Zhihong Liu
- c Pulmonary Vascular Disease Center , Fuwai Hospital, National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Runlin Gao
- a Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases , Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
| | - Yongjian Wu
- a Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases , Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China
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Kang SH, Gogas BD, Jeon KH, Park JS, Lee W, Yoon CH, Suh JW, Hwang SS, Youn TJ, Chae IH, Kim HS. Long-term safety of bioresorbable scaffolds: insights from a network meta-analysis including 91 trials. EUROINTERVENTION 2019; 13:1904-1913. [PMID: 29278353 DOI: 10.4244/eij-d-17-00646] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIMS The aim of this study was to investigate the long-term safety and efficacy of biodegradable scaffolds and metallic stents. METHODS AND RESULTS We analysed a total of 91 randomised controlled trials with a mean follow-up of 3.7 years in 105,842 patients which compared two or more coronary metallic stents or biodegradable scaffolds and reported the long-term clinical outcomes (≥2 years). Network meta-analysis showed that patients treated with the Absorb bioresorbable vascular scaffold (BVS) had a significantly higher risk of definite or probable scaffold thrombosis (ScT) compared to those treated with metallic DES. The risk of very late ScT was highest with the Absorb BVS among comparators. Pairwise conventional meta-analysis demonstrated that the elevated risk of ScT with Absorb BVS compared to cobalt-chromium everolimus-eluting stents was consistent across the time points of ≤30 days (early), 31 days - 1 year (late) and >1 year (very late) ScT. In addition, target lesion failure rates were significantly higher in the Absorb BVS cohort, driven by both increased risk of target vessel myocardial infarction and ischaemia-driven target lesion revascularisation. CONCLUSIONS Absorb BVS implantation was associated with increased risk of long-term and very late ScT compared to current-generation metallic DES. The risk of ScT occurred with a rising trend beyond one year.
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Affiliation(s)
- Si-Hyuck Kang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
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Mahtta D, Elgendy IY. Everolimus-eluting bioresorbable vascular scaffolds: learning from the past to improve the future. Minerva Cardioangiol 2019; 67:288-305. [PMID: 30895764 DOI: 10.23736/s0026-4725.19.04900-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Bioresorbable vascular scaffolds (BVS) were developed to overcome the long-term limitations of metallic drug-eluting stents (DES). Shortcomings of DES include their permanent metallic cage which prevents normal coronary vasomotion, vascular remodeling, precludes future bypass grafting, and creates a nidus for very late stent thrombosis. With its transient scaffold which provides early mechanical support and subsequently resorbs thereby restoring physiologic properties and architecture of the vasculature, BVS offers a promising development within the field of interventional cardiology. Even though various BVS have been or are currently under development, the ABSORB BVS from Abbott Vascular was the first FDA approved device. In this review, we shed light on shortcomings of the current generation DES and theoretical advantages of BVS. In addition, we will discuss in detail clinical data from observational studies, meta-analyses, registries, and randomized controlled trials as it pertains to the efficacy and safety outcomes with everolimus-eluting BVS as compared to the current generation everolimus-eluting metallic stents (EES). We will summarize reasons behind the disappointing results from clinical trials and the failure of first generation BVS leading to its withdrawal from the market. Lastly, we will briefly review ongoing developments with the newer-generation BVS and future pre-clinical and clinical studies that are underway to evaluate the efficacy and safety of second-generation BVS.
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Affiliation(s)
- Dhruv Mahtta
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA -
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Polimeni A, Anadol R, Münzel T, Geyer M, De Rosa S, Indolfi C, Gori T. Bioresorbable vascular scaffolds for percutaneous treatment of chronic total coronary occlusions: a meta-analysis. BMC Cardiovasc Disord 2019; 19:59. [PMID: 30876408 PMCID: PMC6419823 DOI: 10.1186/s12872-019-1042-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 03/12/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND BRS represent a new approach to treating coronary artery disease. Beneficial properties of BRS regarding the restoration of vasomotility after resorption make them attractive devices in CTO revascularization. However, experience in this setting is limited. METHODS We systematically searched Medline, Scholar, and Scopus for reports of at least 9 patients with CTO undergoing BRS implantation. Patients' and procedural characteristics were summarized. The primary outcome of interest was target lesion revascularization (TLR). Pooled estimates were calculated using a random-effects meta-analysis. The study protocol was registered in PROSPERO (CRD42017069322). RESULTS Thirteen reports for a total of 843 lesions with a median follow-up of 12 months (IQR 6-12) were included in the analysis. At short-term, the summary estimate rate of TLR was 2.6% (95% CI: 1 to 4%, I2 = 0%, P = 0.887) while at mid to long-term it was 3.8% (95% CI: 2 to 6%, I2 = 0%, P = 0.803). At long-term follow-up (≥12 months), the summary estimate rate of cardiac death was 1.1% (95% CI: 0 to 2%, I2 = 0%, P = 0.887). The summary estimate rates of scaffold thrombosis and clinical restenosis were respectively 0.9% (95% CI: 0 to 2%, I2 = 0%, P = 0.919) and 1.8% (95% CI: 0 to 4%, I2 = 0%, P = 0.448). Finally, the summary estimate rate of target vessel revascularization was 6.6% (95% CI: 0 to 11%, I2 = 0%, P = 0.04). CONCLUSIONS Implantation of BRS in a population with CTO is feasible, although further longer-term outcome studies are necessary.
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Affiliation(s)
- Alberto Polimeni
- Kardiologie I, Zentrum für Kardiologie, University Medical Center Mainz and DZHK Standort Rhein-Main, Mainz, Germany
- Division of Cardiology, Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy
| | - Remzi Anadol
- Kardiologie I, Zentrum für Kardiologie, University Medical Center Mainz and DZHK Standort Rhein-Main, Mainz, Germany
| | - Thomas Münzel
- Kardiologie I, Zentrum für Kardiologie, University Medical Center Mainz and DZHK Standort Rhein-Main, Mainz, Germany
| | - Martin Geyer
- Kardiologie I, Zentrum für Kardiologie, University Medical Center Mainz and DZHK Standort Rhein-Main, Mainz, Germany
| | - Salvatore De Rosa
- Division of Cardiology, Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy
| | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Sciences, “Magna Graecia” University, 88100 Catanzaro, Italy
- URT-CNR, Department of Medicine, Consiglio Nazionale delle Ricerche of IFC, Viale Europa S/N, 88100 Catanzaro, Italy
| | - Tommaso Gori
- Kardiologie I, Zentrum für Kardiologie, University Medical Center Mainz and DZHK Standort Rhein-Main, Mainz, Germany
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Simonsen JK, Holck EN, Carrié D, Frey N, Lutz M, Weber-Albers J, Dudek D, Chevalier B, Daemen J, Dijkstra J, Fox Maule C, Neghabat O, Lassen JF, Anderson J, Christiansen EH, Abizaid A, Holm NR. Mechanical performance and healing patterns of the novel sirolimus-eluting bioresorbable Fantom scaffold: 6-month and 9-month follow-up by optical coherence tomography in the FANTOM II study. Open Heart 2019; 6:e000941. [PMID: 30997130 PMCID: PMC6443130 DOI: 10.1136/openhrt-2018-000941] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 12/09/2018] [Accepted: 01/20/2019] [Indexed: 11/04/2022] Open
Abstract
Objectives We aimed to evaluate the mechanical properties and healing patterns 6 and 9 months after implantation of the sirolimus-eluting Fantom bioresorbable scaffold (BRS). Background The Fantom BRS (Reva Medical, San Diego, USA) has differentiating properties including radiopacity, strut thickness of 125 µm, high expansion capacity and has demonstrated favourable mid-term clinical and angiographic outcomes. Methods and results FANTOM II was a prospective, single arm study with implantation of the Fantom BRS in 240 patients with stable angina pectoris. Guidance by optical coherence tomography (OCT) was encouraged and was repeated at 6-month (cohort A) or 9-month follow-up (cohort B). Matched baseline and follow-up OCT recordings were available in 152 patients. In-scaffold mean lumen area in cohort A was 6.8±1.7 mm2 and 5.7±1.4 mm2 at baseline and follow-up (p<0.0001) and was 7.2±1.6 mm2 and 5.6±1.4 mm2 in cohort B (p<0.0001). Mean scaffold area remained stable from 7.1±1.5 mm2 at baseline to 7.2±1.4 mm2 at 6 months (p=0.12), and from 7.4±1.5 mm2 to 7.3±1.4 mm2 at 9 months. Strut malapposition was median 0.8 (IQR 0.0;3.5)% and 1.8 (IQR 0.3;6.0)% at baseline and was 0.0 (IQR 0.0;0.0)% in both groups at 6-month and 9-month follow-up. Strut tissue coverage was 98.1 (IQR 95.9;99.4)% at 6 months and 98.9 (IQR 98.3;100.0)% at 9 months. Conclusions The novel Fantom BRS had favourable healing patterns at 6-month and 9-month follow-up as malapposition was effectively resolved and strut coverage was almost complete. The scaffold remained stable through follow-up with no signs of systematic late recoil.
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Affiliation(s)
| | - Emil Nielsen Holck
- Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - Didier Carrié
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | - Norbert Frey
- Department of Cardiology and Angiology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Matthias Lutz
- Department of Cardiology and Angiology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | | | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, University Hospital, Krakow, Poland
| | - Bernard Chevalier
- Department of Cardiology, Institut Cardiovasculaire Paris Sud, Massy, France
| | - Joost Daemen
- Department of Cardiology, Erasmus Universiteit Rotterdam, Rotterdam, Netherlands
| | - Jouke Dijkstra
- Division of Image Processing, Leiden University Medical Center, Leiden, Netherlands
| | - Camilla Fox Maule
- Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | - Omeed Neghabat
- Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
| | | | | | | | | | - Niels Ramsing Holm
- Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus, Denmark
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19
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García-Guimaraes M, Antuña P, Cuesta J, Alfonso F. Early restenosis of resorbable magnesium scaffolds: Optical coherence tomography findings. Catheter Cardiovasc Interv 2018; 93:79-81. [DOI: 10.1002/ccd.27871] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/27/2018] [Accepted: 08/20/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Marcos García-Guimaraes
- Cardiology Department; Hospital Universitario de La Princesa; Madrid Spain
- Instituto de Investigación Sanitaria Hospital Universitario de La Princesa; Madrid Spain
| | - Paula Antuña
- Cardiology Department; Hospital Universitario de La Princesa; Madrid Spain
- Instituto de Investigación Sanitaria Hospital Universitario de La Princesa; Madrid Spain
| | - Javier Cuesta
- Cardiology Department; Hospital Universitario de La Princesa; Madrid Spain
- Instituto de Investigación Sanitaria Hospital Universitario de La Princesa; Madrid Spain
| | - Fernando Alfonso
- Cardiology Department; Hospital Universitario de La Princesa; Madrid Spain
- Instituto de Investigación Sanitaria Hospital Universitario de La Princesa; Madrid Spain
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20
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Al Nooryani A, Elabbassi WN, AlBaba B, Kerfes JA, Abudaqa LM, Bhatia A, Abdelrahman NA, Boskovic N, Beleslin B. Long-term outcome of first 300 implanted Absorb bioresorbable vascular scaffolds in an all-comers Middle East population. J Int Med Res 2018; 47:173-187. [PMID: 30235969 PMCID: PMC6384459 DOI: 10.1177/0300060518798994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives To evaluate long-term clinical outcomes of the Absorb bioresorbable vascular scaffold (BVS) system (Abbott Vascular) in an all-comers Middle East population. Methods This prospective registry study included an initial set of patients with coronary lesions treated using Absorb BVS. Patients were followed for target vessel failure (TVF) including cardiac death, target vessel myocardial infarction (MI), and target lesion revascularization. Results A total of 217 patients (age, 55 ± 11 years; male, 169) with 300 treated lesions were included (median follow-up, 36 months [range, 26–41 months]; complete follow-up, 201 patients). Diabetes mellitus and acute coronary syndrome were present in 50% and 57% of patients, respectively. TVF rate was 32/201 (15.9%), including cardiac death in 10 (5%), target vessel MI in 13 (6.5%), and target lesion revascularization in 22 patients (10.9%). Definite or probable device thrombosis occurred in 11/201 patients (5.5%). TVF was associated with heart failure, worse ejection fraction, multi-vessel BVS, multi BVS in lesion, and total BVS length >50 mm. Conclusions Long-term outcome following Absorb BVS implantation in a population with high prevalence of high-risk and complex patients is acceptable, but heart failure, worse ejection fraction, and multi-vessel or long BVS implantation were associated with worse outcomes.
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Affiliation(s)
- Arif Al Nooryani
- 1 Cardiology Department, Al Qassimi Hospital, Sharjah, United Arab Emirates
| | - Wael N Elabbassi
- 1 Cardiology Department, Al Qassimi Hospital, Sharjah, United Arab Emirates
| | - Bassam AlBaba
- 1 Cardiology Department, Al Qassimi Hospital, Sharjah, United Arab Emirates
| | - Jalal A Kerfes
- 1 Cardiology Department, Al Qassimi Hospital, Sharjah, United Arab Emirates
| | - Loai M Abudaqa
- 1 Cardiology Department, Al Qassimi Hospital, Sharjah, United Arab Emirates
| | - Amit Bhatia
- 1 Cardiology Department, Al Qassimi Hospital, Sharjah, United Arab Emirates
| | | | - Nikola Boskovic
- 2 Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Branko Beleslin
- 2 Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Grimfjärd P, James S, Persson J, Angerås O, Koul S, Omerovic E, Varenhorst C, Lagerqvist B, Erlinge D. Outcome of percutaneous coronary intervention with the Absorb bioresorbable scaffold: data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). EUROINTERVENTION 2018; 13:1303-1310. [PMID: 28781242 DOI: 10.4244/eij-d-17-00458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Randomised trials indicate higher rates of stent thrombosis (ST) and target lesion failure (TLF) after percutaneous coronary intervention (PCI) with the Absorb bioresorbable scaffold (BRS) compared with modern drug-eluting stents (DES). We aimed to investigate the outcome of all Swedish patients treated with the Absorb BRS. METHODS AND RESULTS The Absorb BRS (n=810) was compared with commonly used modern DES (n=67,909). The main outcome measure was definite ST; mean follow-up was two years. Despite being implanted in a younger, lower-risk population compared with modern DES, the Absorb BRS was associated with a higher crude incidence of definite ST at stent level: 1.5 vs. 0.6%, hazard ratio (HR) 2.38 (95% confidence interval [CI]: 1.34-4.23), adjusted HR 4.34 (95% CI: 2.37-7.94); p<0.001. The patient level adjusted HR was 4.44 (95% CI: 2.25-8.77). Rates of in-stent restenosis were similar for BRS and DES. Non-compliance with dual antiplatelet therapy (DAPT) guidelines was noted in six out of 12 BRS ST events. Three very late ST events occurred with the Absorb BRS. CONCLUSIONS In this real-world observational study, the Absorb BRS was associated with a significantly higher risk of definite ST compared with modern DES. Non-compliance with DAPT guideline recommendations was common among Absorb definite ST events.
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Affiliation(s)
- Per Grimfjärd
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
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Xu B, Yang Y, Han Y, Huo Y, Wang L, Qi X, Li J, Chen Y, Kuo HC, Ying SW, Cheong WF, Zhang Y, Su X, Popma JJ, Gao R, Stone GW. Comparison of everolimus-eluting bioresorbable vascular scaffolds and metallic stents: three-year clinical outcomes from the ABSORB China randomised trial. EUROINTERVENTION 2018; 14:e554-e561. [DOI: 10.4244/eij-d-17-00796] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Haude M, Ince H, Kische S, Abizaid A, Tölg R, Alves Lemos P, Van Mieghem NM, Verheye S, von Birgelen C, Christiansen EH, Wijns W, Garcia-Garcia HM, Waksman R. Sustained safety and clinical performance of a drug-eluting absorbable metal scaffold up to 24 months: pooled outcomes of BIOSOLVE-II and BIOSOLVE-III. EUROINTERVENTION 2018; 13:432-439. [PMID: 28504239 DOI: 10.4244/eij-d-17-00254] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIMS We aimed to assess the safety and performance of the DREAMS 2G scaffold up to 24 months post implant. METHODS AND RESULTS The present study population comprises a total of 184 patients with 189 lesions who were enrolled in the prospective, multicentre BIOSOLVE-II and BIOSOLVE-III trials. Clinical follow-up was scheduled at one, six, 12, 24 and 36 months. The present report includes pooled follow-up data at six months and BIOSOLVE-II data at 24 months. Patients were 65.5±10.8 years old, and lesions were 12.5±5.1 mm long with reference diameters of 2.7±0.4 mm. Procedural success was obtained in 97.8%. At six months, the composite clinical endpoint target lesion failure was 3.3% (95% CI: 1.2-7.1), based on two cardiac deaths (1.1%, one unknown and one not device-related), one target vessel myocardial infarction (0.6%), and three clinically driven target lesion revascularisations (1.7%). For BIOSOLVE-II at 24 months, the target lesion failure rate was 5.9% (95% CI: 2.4-11.8), based on two cardiac deaths (1.7%), one target vessel myocardial infarction (0.9%) and four target lesion revascularisations (3.4%). There was no definite or probable scaffold thrombosis. CONCLUSIONS The present analysis provides additional evidence on the safety of a drug-eluting absorbable metal scaffold with promising clinical outcomes up to 24 months and absence of definite or probable scaffold thrombosis.
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Affiliation(s)
- Michael Haude
- Medical Clinic I, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Neuss, Germany
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Mahmoud AN, Barakat AF, Elgendy AY, Schneibel E, Mentias A, Abuzaid A, Elgendy IY. Long-Term Efficacy and Safety of Everolimus-Eluting Bioresorbable Vascular Scaffolds Versus Everolimus-Eluting Metallic Stents: A Meta-Analysis of Randomized Trials. Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.117.005286. [PMID: 28468954 DOI: 10.1161/circinterventions.117.005286] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 04/11/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Data regarding the long-term efficacy and safety of everolimus-eluting bioresorbable vascular scaffolds (BVS) compared with everolimus-eluting stents are limited. This meta-analysis aimed to compare the long-term outcomes with both devices. METHODS AND RESULTS Randomized trials reporting clinical outcomes beyond 1 year and comparing BVS with everolimus-eluting stents were included. Summary estimates risk ratios (RRs) were constructed. The primary efficacy outcome was target lesion failure, defined as cardiac death, target vessel myocardial infarction, and ischemia-driven target lesion revascularization, and the primary safety outcome was definite or probable stent/scaffold thrombosis. Six trials with 5392 patients were included (mean follow-up, 25 months). BVS had a higher rate of target lesion failure (RR, 1.33; 95% confidence interval [CI], 1.11-1.58) driven by the higher rates of target vessel myocardial infarction (RR, 1.65; 95% CI, 1.26-2.17) and target lesion revascularization (RR, 1.39; 95% CI, 1.08-1.78). The risk of definite or probable stent/scaffold thrombosis (RR, 3.22; 95% CI, 1.89-5.49) and very late stent/scaffold thrombosis (>1 year; RR, 4.78; 95% CI, 1.66-13.8) was higher with BVS. The risk of cardiac and all-cause mortality was similar in both groups. CONCLUSIONS Compared with everolimus-eluting stents, BVS is associated with increased risk of target lesion failure driven by the increased rates of target vessel myocardial infarction and ischemia-driven target lesion revascularization in these studies (mean follow-up, 25 months). The risk of definite or probable stent/scaffold thrombosis and very late stent/scaffold thrombosis seems to be higher with BVS. Further information from randomized trials is critical to evaluate clinical outcomes with BVS on complete resolution of the scaffold.
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Affiliation(s)
- Ahmed N Mahmoud
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville (A.N.M., A.Y.E., E.S., I.Y.E.); Department of Medicine, Cleveland Clinic Foundation, OH (A.F.B.); Division of Cardiovascular Medicine, Department of Medicine, University of Iowa Carver College of Medicine (A.M.); and Department of Cardiovascular Medicine, Sidney Kimmel Medical College at Thomas Jefferson University/Christiana Care Health System, Newark, DE (A.A.)
| | - Amr F Barakat
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville (A.N.M., A.Y.E., E.S., I.Y.E.); Department of Medicine, Cleveland Clinic Foundation, OH (A.F.B.); Division of Cardiovascular Medicine, Department of Medicine, University of Iowa Carver College of Medicine (A.M.); and Department of Cardiovascular Medicine, Sidney Kimmel Medical College at Thomas Jefferson University/Christiana Care Health System, Newark, DE (A.A.)
| | - Akram Y Elgendy
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville (A.N.M., A.Y.E., E.S., I.Y.E.); Department of Medicine, Cleveland Clinic Foundation, OH (A.F.B.); Division of Cardiovascular Medicine, Department of Medicine, University of Iowa Carver College of Medicine (A.M.); and Department of Cardiovascular Medicine, Sidney Kimmel Medical College at Thomas Jefferson University/Christiana Care Health System, Newark, DE (A.A.)
| | - Erik Schneibel
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville (A.N.M., A.Y.E., E.S., I.Y.E.); Department of Medicine, Cleveland Clinic Foundation, OH (A.F.B.); Division of Cardiovascular Medicine, Department of Medicine, University of Iowa Carver College of Medicine (A.M.); and Department of Cardiovascular Medicine, Sidney Kimmel Medical College at Thomas Jefferson University/Christiana Care Health System, Newark, DE (A.A.)
| | - Amgad Mentias
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville (A.N.M., A.Y.E., E.S., I.Y.E.); Department of Medicine, Cleveland Clinic Foundation, OH (A.F.B.); Division of Cardiovascular Medicine, Department of Medicine, University of Iowa Carver College of Medicine (A.M.); and Department of Cardiovascular Medicine, Sidney Kimmel Medical College at Thomas Jefferson University/Christiana Care Health System, Newark, DE (A.A.)
| | - Ahmed Abuzaid
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville (A.N.M., A.Y.E., E.S., I.Y.E.); Department of Medicine, Cleveland Clinic Foundation, OH (A.F.B.); Division of Cardiovascular Medicine, Department of Medicine, University of Iowa Carver College of Medicine (A.M.); and Department of Cardiovascular Medicine, Sidney Kimmel Medical College at Thomas Jefferson University/Christiana Care Health System, Newark, DE (A.A.)
| | - Islam Y Elgendy
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville (A.N.M., A.Y.E., E.S., I.Y.E.); Department of Medicine, Cleveland Clinic Foundation, OH (A.F.B.); Division of Cardiovascular Medicine, Department of Medicine, University of Iowa Carver College of Medicine (A.M.); and Department of Cardiovascular Medicine, Sidney Kimmel Medical College at Thomas Jefferson University/Christiana Care Health System, Newark, DE (A.A.)
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Scaffold thrombosis following implantation of the ABSORB BVS in routine clinical practice: Insight into possible mechanisms from optical coherence tomography. Catheter Cardiovasc Interv 2018; 92:E106-E114. [DOI: 10.1002/ccd.27475] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/28/2017] [Accepted: 11/25/2017] [Indexed: 11/07/2022]
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26
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Anadol R, Gori T. The mechanisms of late scaffold thrombosis. Clin Hemorheol Microcirc 2017; 67:343-346. [DOI: 10.3233/ch-179214] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Remzi Anadol
- Kardiologie I, University Medical Center Mainz and Deutsches Zentrum für Herz und Kreislauf Forschung, Mainz, Germany
| | - Tommaso Gori
- Kardiologie I, University Medical Center Mainz and Deutsches Zentrum für Herz und Kreislauf Forschung, Mainz, Germany
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Tanaka A, Jabbour RJ, Mitomo S, Latib A, Colombo A. Hybrid Percutaneous Coronary Intervention With Bioresorbable Vascular Scaffolds in Combination With Drug-Eluting Stents or Drug-Coated Balloons for Complex Coronary Lesions. JACC Cardiovasc Interv 2017; 10:539-547. [PMID: 28335892 DOI: 10.1016/j.jcin.2016.12.285] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 12/05/2016] [Accepted: 12/29/2016] [Indexed: 12/26/2022]
Abstract
Bioresorbable vascular scaffolds (BVS) have become an attractive option in the percutaneous coronary intervention field due to the potential advantages associated with the complete resorption process that occurs within a few years. However, current-generation BVS have several limitations including thicker struts, reduced radial strength, and limited expansion capability when compared with drug-eluting stents (DES). As a result, complex coronary disease often contains BVS-inappropriate/unfavorable segments. This does not necessarily mean that BVS use must be completely avoided, and minimizing the length of permanent metallic caging may still be advantageous. Operators should fully understand the limitations of current BVS, and when to consider a hybrid strategy of BVS in combination with DES or drug-coated balloons.
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Affiliation(s)
- Akihito Tanaka
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Richard J Jabbour
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy; Department of Cardiology, Imperial College London, London, United Kingdom
| | - Satoru Mitomo
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Azeem Latib
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy; Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
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Capodanno D, Angiolillo DJ. Antiplatelet Therapy After Implantation of Bioresorbable Vascular Scaffolds: A Review of the Published Data, Practical Recommendations, and Future Directions. JACC Cardiovasc Interv 2017; 10:425-437. [PMID: 28279311 DOI: 10.1016/j.jcin.2016.12.279] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/15/2016] [Accepted: 12/15/2016] [Indexed: 12/24/2022]
Abstract
The introduction of bioresorbable vascular scaffolds (BVS) for clinical use has raised a number of questions on whether current dual-antiplatelet therapy (DAPT) recommendations after drug-eluting stent (DES) implantation, mostly deriving from data on second-generation DES, are also applicable to this completely different technology. This article aims to review the technical shortcomings of BVS-the most extensively studied fully bioresorbable coronary stent-and its contemporary rates of scaffold thrombosis, with a focus on recommendations for DAPT duration.
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29
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Katsikis A, Serruys PW. Bioresorbable scaffolds versus metallic stents in routine PCI: the plot thickens. J Thorac Dis 2017; 9:2296-2300. [PMID: 28932529 DOI: 10.21037/jtd.2017.07.72] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Athanasios Katsikis
- 401 General Military Hospital of Athens, Cardiology Department, Athens, Greece
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30
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Cassese S, Kastrati A, Fusaro M. Bioresorbable vascular scaffolds for complex coronary anatomies: "Icarus' flight" for interventional cardiologists? Cardiovasc Diagn Ther 2017; 7:S98-S101. [PMID: 28748158 DOI: 10.21037/cdt.2017.01.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Massimiliano Fusaro
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
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31
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Wykrzykowska JJ, Kraak RP, Hofma SH, van der Schaaf RJ, Arkenbout EK, IJsselmuiden AJ, Elias J, van Dongen IM, Tijssen RYG, Koch KT, Baan J, Vis MM, de Winter RJ, Piek JJ, Tijssen JGP, Henriques JPS. Bioresorbable Scaffolds versus Metallic Stents in Routine PCI. N Engl J Med 2017; 376:2319-2328. [PMID: 28402237 DOI: 10.1056/nejmoa1614954] [Citation(s) in RCA: 326] [Impact Index Per Article: 46.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Bioresorbable vascular scaffolds were developed to overcome the shortcomings of drug-eluting stents in percutaneous coronary intervention (PCI). We performed an investigator-initiated, randomized trial to compare an everolimus-eluting bioresorbable scaffold with an everolimus-eluting metallic stent in the context of routine clinical practice. METHODS We randomly assigned 1845 patients undergoing PCI to receive either a bioresorbable vascular scaffold (924 patients) or a metallic stent (921 patients). The primary end point was target-vessel failure (a composite of cardiac death, target-vessel myocardial infarction, or target-vessel revascularization). The data and safety monitoring board recommended early reporting of the study results because of safety concerns. This report provides descriptive information on end-point events. RESULTS The median follow-up was 707 days. Target-vessel failure occurred in 105 patients in the scaffold group and in 94 patients in the stent group (2-year cumulative event rates, 11.7% and 10.7%, respectively; hazard ratio, 1.12; 95% confidence interval [CI], 0.85 to 1.48; P=0.43); event rates were based on Kaplan-Meier estimates in time-to-event analyses. Cardiac death occurred in 18 patients in the scaffold group and in 23 patients in the stent group (2-year cumulative event rates, 2.0% and 2.7%, respectively), target-vessel myocardial infarction occurred in 48 patients in the scaffold group and in 30 patients in the stent group (2-year cumulative event rates, 5.5% and 3.2%), and target-vessel revascularization occurred in 76 patients in the scaffold group and in 65 patients in the stent group (2-year cumulative event rates, 8.7% and 7.5%). Definite or probable device thrombosis occurred in 31 patients in the scaffold group as compared with 8 patients in the stent group (2-year cumulative event rates, 3.5% vs. 0.9%; hazard ratio, 3.87; 95% CI, 1.78 to 8.42; P<0.001). CONCLUSIONS In this preliminary report of a trial involving patients undergoing PCI, there was no significant difference in the rate of target-vessel failure between the patients who received a bioresorbable scaffold and the patients who received a metallic stent. The bioresorbable scaffold was associated with a higher incidence of device thrombosis than the metallic stent through 2 years of follow-up. (Funded by Abbott Vascular; AIDA ClinicalTrials.gov number, NCT01858077 .).
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Affiliation(s)
- Joanna J Wykrzykowska
- From the AMC Heartcenter, Academic Medical Center-University of Amsterdam (J.J.W., R.P.K., J.E., I.M.D., R.Y.G.T., K.T.K., J.B., M.M.V., R.J.W., J.J.P., J.G.P.T., J.P.S.H.), and the Department of Cardiology, Onze Lieve Vrouwe Gasthuis (R.J.S.), Amsterdam, the Department of Cardiology, Medical Center Leeuwarden, Leeuwarden (S.H.H.), the Department of Cardiology, Tergooi Hospital, Blaricum (E.K.A.), and the Department of Cardiology, Albert Schweitzer Hospital, Dordrecht (A.J.IJ.) - all in the Netherlands
| | - Robin P Kraak
- From the AMC Heartcenter, Academic Medical Center-University of Amsterdam (J.J.W., R.P.K., J.E., I.M.D., R.Y.G.T., K.T.K., J.B., M.M.V., R.J.W., J.J.P., J.G.P.T., J.P.S.H.), and the Department of Cardiology, Onze Lieve Vrouwe Gasthuis (R.J.S.), Amsterdam, the Department of Cardiology, Medical Center Leeuwarden, Leeuwarden (S.H.H.), the Department of Cardiology, Tergooi Hospital, Blaricum (E.K.A.), and the Department of Cardiology, Albert Schweitzer Hospital, Dordrecht (A.J.IJ.) - all in the Netherlands
| | - Sjoerd H Hofma
- From the AMC Heartcenter, Academic Medical Center-University of Amsterdam (J.J.W., R.P.K., J.E., I.M.D., R.Y.G.T., K.T.K., J.B., M.M.V., R.J.W., J.J.P., J.G.P.T., J.P.S.H.), and the Department of Cardiology, Onze Lieve Vrouwe Gasthuis (R.J.S.), Amsterdam, the Department of Cardiology, Medical Center Leeuwarden, Leeuwarden (S.H.H.), the Department of Cardiology, Tergooi Hospital, Blaricum (E.K.A.), and the Department of Cardiology, Albert Schweitzer Hospital, Dordrecht (A.J.IJ.) - all in the Netherlands
| | - Rene J van der Schaaf
- From the AMC Heartcenter, Academic Medical Center-University of Amsterdam (J.J.W., R.P.K., J.E., I.M.D., R.Y.G.T., K.T.K., J.B., M.M.V., R.J.W., J.J.P., J.G.P.T., J.P.S.H.), and the Department of Cardiology, Onze Lieve Vrouwe Gasthuis (R.J.S.), Amsterdam, the Department of Cardiology, Medical Center Leeuwarden, Leeuwarden (S.H.H.), the Department of Cardiology, Tergooi Hospital, Blaricum (E.K.A.), and the Department of Cardiology, Albert Schweitzer Hospital, Dordrecht (A.J.IJ.) - all in the Netherlands
| | - E Karin Arkenbout
- From the AMC Heartcenter, Academic Medical Center-University of Amsterdam (J.J.W., R.P.K., J.E., I.M.D., R.Y.G.T., K.T.K., J.B., M.M.V., R.J.W., J.J.P., J.G.P.T., J.P.S.H.), and the Department of Cardiology, Onze Lieve Vrouwe Gasthuis (R.J.S.), Amsterdam, the Department of Cardiology, Medical Center Leeuwarden, Leeuwarden (S.H.H.), the Department of Cardiology, Tergooi Hospital, Blaricum (E.K.A.), and the Department of Cardiology, Albert Schweitzer Hospital, Dordrecht (A.J.IJ.) - all in the Netherlands
| | - Alexander J IJsselmuiden
- From the AMC Heartcenter, Academic Medical Center-University of Amsterdam (J.J.W., R.P.K., J.E., I.M.D., R.Y.G.T., K.T.K., J.B., M.M.V., R.J.W., J.J.P., J.G.P.T., J.P.S.H.), and the Department of Cardiology, Onze Lieve Vrouwe Gasthuis (R.J.S.), Amsterdam, the Department of Cardiology, Medical Center Leeuwarden, Leeuwarden (S.H.H.), the Department of Cardiology, Tergooi Hospital, Blaricum (E.K.A.), and the Department of Cardiology, Albert Schweitzer Hospital, Dordrecht (A.J.IJ.) - all in the Netherlands
| | - Joëlle Elias
- From the AMC Heartcenter, Academic Medical Center-University of Amsterdam (J.J.W., R.P.K., J.E., I.M.D., R.Y.G.T., K.T.K., J.B., M.M.V., R.J.W., J.J.P., J.G.P.T., J.P.S.H.), and the Department of Cardiology, Onze Lieve Vrouwe Gasthuis (R.J.S.), Amsterdam, the Department of Cardiology, Medical Center Leeuwarden, Leeuwarden (S.H.H.), the Department of Cardiology, Tergooi Hospital, Blaricum (E.K.A.), and the Department of Cardiology, Albert Schweitzer Hospital, Dordrecht (A.J.IJ.) - all in the Netherlands
| | - Ivo M van Dongen
- From the AMC Heartcenter, Academic Medical Center-University of Amsterdam (J.J.W., R.P.K., J.E., I.M.D., R.Y.G.T., K.T.K., J.B., M.M.V., R.J.W., J.J.P., J.G.P.T., J.P.S.H.), and the Department of Cardiology, Onze Lieve Vrouwe Gasthuis (R.J.S.), Amsterdam, the Department of Cardiology, Medical Center Leeuwarden, Leeuwarden (S.H.H.), the Department of Cardiology, Tergooi Hospital, Blaricum (E.K.A.), and the Department of Cardiology, Albert Schweitzer Hospital, Dordrecht (A.J.IJ.) - all in the Netherlands
| | - Ruben Y G Tijssen
- From the AMC Heartcenter, Academic Medical Center-University of Amsterdam (J.J.W., R.P.K., J.E., I.M.D., R.Y.G.T., K.T.K., J.B., M.M.V., R.J.W., J.J.P., J.G.P.T., J.P.S.H.), and the Department of Cardiology, Onze Lieve Vrouwe Gasthuis (R.J.S.), Amsterdam, the Department of Cardiology, Medical Center Leeuwarden, Leeuwarden (S.H.H.), the Department of Cardiology, Tergooi Hospital, Blaricum (E.K.A.), and the Department of Cardiology, Albert Schweitzer Hospital, Dordrecht (A.J.IJ.) - all in the Netherlands
| | - Karel T Koch
- From the AMC Heartcenter, Academic Medical Center-University of Amsterdam (J.J.W., R.P.K., J.E., I.M.D., R.Y.G.T., K.T.K., J.B., M.M.V., R.J.W., J.J.P., J.G.P.T., J.P.S.H.), and the Department of Cardiology, Onze Lieve Vrouwe Gasthuis (R.J.S.), Amsterdam, the Department of Cardiology, Medical Center Leeuwarden, Leeuwarden (S.H.H.), the Department of Cardiology, Tergooi Hospital, Blaricum (E.K.A.), and the Department of Cardiology, Albert Schweitzer Hospital, Dordrecht (A.J.IJ.) - all in the Netherlands
| | - Jan Baan
- From the AMC Heartcenter, Academic Medical Center-University of Amsterdam (J.J.W., R.P.K., J.E., I.M.D., R.Y.G.T., K.T.K., J.B., M.M.V., R.J.W., J.J.P., J.G.P.T., J.P.S.H.), and the Department of Cardiology, Onze Lieve Vrouwe Gasthuis (R.J.S.), Amsterdam, the Department of Cardiology, Medical Center Leeuwarden, Leeuwarden (S.H.H.), the Department of Cardiology, Tergooi Hospital, Blaricum (E.K.A.), and the Department of Cardiology, Albert Schweitzer Hospital, Dordrecht (A.J.IJ.) - all in the Netherlands
| | - M Marije Vis
- From the AMC Heartcenter, Academic Medical Center-University of Amsterdam (J.J.W., R.P.K., J.E., I.M.D., R.Y.G.T., K.T.K., J.B., M.M.V., R.J.W., J.J.P., J.G.P.T., J.P.S.H.), and the Department of Cardiology, Onze Lieve Vrouwe Gasthuis (R.J.S.), Amsterdam, the Department of Cardiology, Medical Center Leeuwarden, Leeuwarden (S.H.H.), the Department of Cardiology, Tergooi Hospital, Blaricum (E.K.A.), and the Department of Cardiology, Albert Schweitzer Hospital, Dordrecht (A.J.IJ.) - all in the Netherlands
| | - Robbert J de Winter
- From the AMC Heartcenter, Academic Medical Center-University of Amsterdam (J.J.W., R.P.K., J.E., I.M.D., R.Y.G.T., K.T.K., J.B., M.M.V., R.J.W., J.J.P., J.G.P.T., J.P.S.H.), and the Department of Cardiology, Onze Lieve Vrouwe Gasthuis (R.J.S.), Amsterdam, the Department of Cardiology, Medical Center Leeuwarden, Leeuwarden (S.H.H.), the Department of Cardiology, Tergooi Hospital, Blaricum (E.K.A.), and the Department of Cardiology, Albert Schweitzer Hospital, Dordrecht (A.J.IJ.) - all in the Netherlands
| | - Jan J Piek
- From the AMC Heartcenter, Academic Medical Center-University of Amsterdam (J.J.W., R.P.K., J.E., I.M.D., R.Y.G.T., K.T.K., J.B., M.M.V., R.J.W., J.J.P., J.G.P.T., J.P.S.H.), and the Department of Cardiology, Onze Lieve Vrouwe Gasthuis (R.J.S.), Amsterdam, the Department of Cardiology, Medical Center Leeuwarden, Leeuwarden (S.H.H.), the Department of Cardiology, Tergooi Hospital, Blaricum (E.K.A.), and the Department of Cardiology, Albert Schweitzer Hospital, Dordrecht (A.J.IJ.) - all in the Netherlands
| | - Jan G P Tijssen
- From the AMC Heartcenter, Academic Medical Center-University of Amsterdam (J.J.W., R.P.K., J.E., I.M.D., R.Y.G.T., K.T.K., J.B., M.M.V., R.J.W., J.J.P., J.G.P.T., J.P.S.H.), and the Department of Cardiology, Onze Lieve Vrouwe Gasthuis (R.J.S.), Amsterdam, the Department of Cardiology, Medical Center Leeuwarden, Leeuwarden (S.H.H.), the Department of Cardiology, Tergooi Hospital, Blaricum (E.K.A.), and the Department of Cardiology, Albert Schweitzer Hospital, Dordrecht (A.J.IJ.) - all in the Netherlands
| | - Jose P S Henriques
- From the AMC Heartcenter, Academic Medical Center-University of Amsterdam (J.J.W., R.P.K., J.E., I.M.D., R.Y.G.T., K.T.K., J.B., M.M.V., R.J.W., J.J.P., J.G.P.T., J.P.S.H.), and the Department of Cardiology, Onze Lieve Vrouwe Gasthuis (R.J.S.), Amsterdam, the Department of Cardiology, Medical Center Leeuwarden, Leeuwarden (S.H.H.), the Department of Cardiology, Tergooi Hospital, Blaricum (E.K.A.), and the Department of Cardiology, Albert Schweitzer Hospital, Dordrecht (A.J.IJ.) - all in the Netherlands
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Polimeni A, Anadol R, Münzel T, Indolfi C, De Rosa S, Gori T. Long-term outcome of bioresorbable vascular scaffolds for the treatment of coronary artery disease: a meta-analysis of RCTs. BMC Cardiovasc Disord 2017; 17:147. [PMID: 28592227 PMCID: PMC5463321 DOI: 10.1186/s12872-017-0586-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 06/01/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Coronary bioresorbable scaffolds (BRS) were developed to overcome the limitations of standard metallic stents, especially to address late events after percutaneous coronary interventions. The aim of this meta-analysis was to evaluate the efficacy and safety of BRS, compared with Everolimus-eluting stents (EES), using the data available from randomized trials, with a focus on long-term outcomes. METHODS Published randomized trials comparing BRS to EES for the treatment of coronary artery disease were searched for within PubMed, Cochrane Library and Scopus electronic databases up to April 4th 2017. The summary measure used was odds ratio (OR) with 95% confidence intervals. RESULTS A total of 5 studies were eligible, including 5219 patients. At 2 years, BRS was associated with higher rates of target lesion failure (9.4% vs 7.2%; OR = 1.33; 95% CI 1.07 to 1.63; p = 0.008) and device thrombosis (2.3% vs 0.7%; OR = 3.22; 95% CI 1.86 to 5.57; p < 0.0001) compared with EES. The incidence of both early (within 30 days after implantation, 1.1% vs 0.5%, OR 1.97, 95% CI 1.02 to 3.81; p = 0.05) and very-late device thrombosis (>1 year, 0.6% vs 0.1%, OR 4.03, 95% CI 1.37 to 11.82; p = 0.01) was higher with BRS compared with EES. CONCLUSIONS BRS may be associated with worse two-years clinical outcomes compared with EES in patients with coronary artery disease.
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Affiliation(s)
- Alberto Polimeni
- Zentrum für Kardiologie, University Hospital Mainz, Mainz, Germany.,German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, Mainz, Germany.,Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, 88100, Catanzaro, Italy
| | - Remzi Anadol
- Zentrum für Kardiologie, University Hospital Mainz, Mainz, Germany.,German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, Mainz, Germany
| | - Thomas Münzel
- Zentrum für Kardiologie, University Hospital Mainz, Mainz, Germany.,German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, Mainz, Germany
| | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, 88100, Catanzaro, Italy.,URT-CNR, Department of Medicine, Consiglio Nazionale delle Ricerche of IFC, Viale Europa S/N, 88100, Catanzaro, Italy
| | - Salvatore De Rosa
- Division of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, 88100, Catanzaro, Italy
| | - Tommaso Gori
- Zentrum für Kardiologie, University Hospital Mainz, Mainz, Germany. .,German Center for Cardiac and Vascular Research (DZHK), Standort Rhein-Main, Mainz, Germany.
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Wiebe J, Hoppmann P, Colleran R, Kufner S, Valeskini M, Cassese S, Schneider S, Joner M, Schunkert H, Laugwitz KL, Kastrati A, Byrne RA. Long-Term Clinical Outcomes of Patients Treated With Everolimus-Eluting Bioresorbable Stents in Routine Practice. JACC Cardiovasc Interv 2017. [DOI: 10.1016/j.jcin.2017.03.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Arroyo D, Gendre G, Schukraft S, Kallinikou Z, Müller O, Baeriswyl G, Stauffer JC, Goy JJ, Togni M, Cook S, Puricel S. Comparison of everolimus- and biolimus-eluting coronary stents with everolimus-eluting bioresorbable vascular scaffolds: Two-year clinical outcomes of the EVERBIO II trial. Int J Cardiol 2017; 243:121-125. [PMID: 28576627 DOI: 10.1016/j.ijcard.2017.05.053] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 05/08/2017] [Accepted: 05/11/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Data from randomized controlled trials have shown that the ABSORB BVS is non-inferior to Cobalt Chromium everolimus-eluting stents at 2years. METHODS & RESULTS The EVERBIO II trial (Comparison of Everolimus- and Biolimus-Eluting Coronary Stents with Everolimus-Eluting Bioresorbable Vascular Scaffold) is a single-center, assessor-blind, randomized controlled trial enrolling 240 patients with an allocation ration of 1:1:1 conducted at University and Hospital Fribourg, Switzerland. The studied devices were an everolimus-eluting persistent polymer stent (EES), a biolimus-eluting stent with bioabsorbable polymer (BES) and a fully bioresorbable vascular scaffold (BVS). Clinical end points collected at 9months, 12months, and 2years, were academic research consortium defined composites, device thrombosis and target-vessel revascularization. Clinical follow-up at 2years was available in 96% (N=77) of patients in the EES group, in 100% (N=80) in the BES and 99% (N=77) in the BVS group. The device-oriented composite end point of cardiac death, target-vessel myocardial infarction and target-lesion revascularization occurred in 13 (16%) patients treated with EES, in 7 (9%) patients treated with BES and in 16 (21%) patients treated with BVS. There was no significant difference when the metallic stents were compared to the BVS (p=0.12). There was one late scaffold thrombosis throughout the trial in the BVS group, and no definite stent thrombosis in either EES or BES treated patients. CONCLUSIONS The current analysis shows no significant differences with regard to clinical outcomes at 2years between BVS and the best-in-class metallic DES. Event rates were numerically higher in BVS-treated patients. However, when BVS were compared to BES alone, the occurrence of device related adverse events was significantly increased.
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Affiliation(s)
- Diego Arroyo
- Hospital & University Fribourg, Fribourg, Switzerland
| | | | | | | | - Olivier Müller
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | | | | | - Mario Togni
- Hospital & University Fribourg, Fribourg, Switzerland
| | - Stéphane Cook
- Hospital & University Fribourg, Fribourg, Switzerland
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Campos CM, Caixeta A, Franken M, Bartorelli AL, Whitbourn RJ, Wu CJ, Li Paul Kao H, Rosli MA, Carrie D, De Bruyne B, Stone GW, Serruys PW, Abizaid A. Risk and timing of clinical events according to diabetic status of patients treated with everolimus-eluting bioresorbable vascular scaffolds versus everolimus-eluting stent: 2-year results from a propensity score matched comparison of ABSORB EXTEND and SPIRIT trials. Catheter Cardiovasc Interv 2017; 91:387-395. [PMID: 28471086 DOI: 10.1002/ccd.27109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 03/01/2017] [Accepted: 03/25/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVES to compare the occurrence of clinical events in diabetics treated with the Absorb bioresorbable vascular scaffold (Absorb BVS; Abbott Vascular, Santa Clara, CA) versus everolimus-eluting metal stents (EES; XIENCE V; Abbott Vascular, Santa Clara, CA) BACKGROUND: There are limited data dedicated to clinical outcomes of diabetic patients treated with bioresorbable scaffolds (BRS) at 2-year horizon. METHODS The present study included 812 patients in the ABSORB EXTEND study in which a total of 215 diabetic patients were treated with Absorb BVS. In addition, 882 diabetic patients treated with EES in pooled data from the SPIRIT clinical program (SPIRIT II, SPIRIT III and SPIRIT IV trials) were used for comparison by applying propensity score matching using 29 different variables. The primary endpoint was ischemia driven major adverse cardiac events (ID-MACE), including cardiac death, myocardial infarction (MI), and ischemia driven target lesion revascularization (ID-TLR). RESULTS After 2 years, the ID-MACE rate was 6.5% in the Absorb BVS vs. 8.9% in the Xience group (P = 0.40). There was no difference for MACE components or definite/probable device thrombosis (HR: 1.43 [0.24,8.58]; P = 0.69). The occurrence of MACE was not different for both diabetic status (insulin- and non-insulin-requiring diabetes) in all time points up to the 2-year follow-up for the Absorb and Xience groups. CONCLUSION In this largest ever patient-level pooled comparison on the treatment of diabetic patients with BRS out to two years, individuals with diabetes treated with the Absorb BVS had a similar rate of MACE as compared with diabetics treated with the Xience EES. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Carlos M Campos
- Department of Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Adriano Caixeta
- Department of Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marcelo Franken
- Department of Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Robert J Whitbourn
- Department of Cardiology, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Chiung-Jen Wu
- Department of Cardiology, Chang Gung Memorial Hospital, Niao-Sung Hsiang, Taiwan
| | - Hsien Li Paul Kao
- Department of Cardiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Mohd Ali Rosli
- Department of Cardiology, Institute Jantung Negara, Kuala Lumpur, Malaysia
| | - Didier Carrie
- Department of Cardiology, Hôpital de Rangueil CHU, Toulouse, France
| | | | - Gregg W Stone
- Department of Interventional Cardiology, Columbia University Medical Center, New York.,Cardiovascular Research Foundation, New York
| | - Patrick W Serruys
- International Centre for Circulatory Health, NHLI, Imperial College London, United Kingdom
| | - Alexandre Abizaid
- Department of Interventional Cardiology, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
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Nairooz R, Saad M, Sardar P, Aronow WS. Two-year outcomes of bioresorbable vascular scaffold versus drug-eluting stents in coronary artery disease: a meta-analysis. Heart 2017; 103:1096-1103. [PMID: 28115471 DOI: 10.1136/heartjnl-2016-310886] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 12/14/2016] [Accepted: 12/15/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Data regarding long-term clinical outcomes with everolimus-eluting bioresorbable vascular scaffold (BVS) versus second-generation drug-eluting stents (DES) are scarce. METHODS We searched online databases until October 2016 for studies comparing BVS versus DES reporting outcomes at 2 years of follow-up. We performed a meta-analysis comparing BVS with DES across the spectrum of coronary artery disease (CAD). Random effects model OR was calculated for outcomes of interest including device-oriented composite events (DOCE; defined as composite of cardiac mortality, target vessel myocardial infarction (TV-MI), and ischaemia-driven target lesion revascularisation (TLR)), all-cause mortality, definite stent thrombosis, TV-MI and TLR. RESULTS A total of 2360 patients enrolled in five studies met criteria for inclusion in this analysis. At 2 years, BVS was associated with higher rates of DOCE (6.9% vs 4.5%, OR=1.53; 95% CI 1.06 to 2.23; p=0.02), absolute risk increase (ARI) 2.4%, relative risk increase (RRI) 53%, TV-MI (4% vs 1.8%, OR=1.94; 95% CI 1.02 to 3.67; p=0.04), ARI 2.2%, RRI 122% and definite stent thrombosis (2.1% vs 0.6%, OR=3.39; 95% CI 1.46 to 7.88; p=0.005), ARI 1.5%, RRI 250% compared with DES. No differences in all-cause mortality (OR=0.86; 95% CI 0.26 to 2.81; p=0.80) and TLR (OR=1.44; 95% CI 0.81 to 2.54; p=0.21) were observed between both groups. CONCLUSIONS BVS may be associated with worse long-term clinical outcomes compared with DES. Randomised clinical trials are encouraged to expeditiously report long-term safety and efficacy outcomes and identify predictors of adverse events with BVS compared with DES.
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Affiliation(s)
- Ramez Nairooz
- Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Marwan Saad
- Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Partha Sardar
- Division of Cardiovascular Medicine, University of Utah, Utah, USA
| | - Wilbert S Aronow
- Division of Cardiovascular Medicine, Westchester Medical Center-New York Medical College, New York, USA
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Very Late Scaffold Thrombosis of Bioresorbable Vascular Scaffold. JACC Cardiovasc Interv 2017; 10:27-37. [DOI: 10.1016/j.jcin.2016.10.027] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 10/20/2016] [Indexed: 11/21/2022]
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Cyrne Carvalho H. Comentário a «Comparação aleatorizada das próteses intracoronárias totalmente bioabsorvíveis eluidoras de everolimus com os stents metálicos eluidores de everolimus para o tratamento da doença cardíaca isquémica causada por lesões arteriais coronária de novo: resultados a dois anos do ensaio ABSORB II». Rev Port Cardiol 2017. [DOI: 10.1016/j.repc.2016.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Cyrne Carvalho H. Comentário a «Comparação aleatorizada das próteses intracoronárias totalmente bioabsorvíveis eluidoras de everolimus com os stents metálicos eluidores de everolimus para o tratamento da doença cardíaca isquémica causada por lesões arteriais coronária de novo: resultados a dois anos do ensaio ABSORB II». REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2016.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Collet C, Serruys P. Very late scaffold thrombosis after bioresorbable scaffold implantation: an unexpected new enemy on the horizon… or just a false alarm? EUROINTERVENTION 2016; 12:1077-1079. [DOI: 10.4244/eijv12i9a176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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