Long-Term Efficacy and Safety of Everolimus-Eluting Bioresorbable Vascular Scaffolds Versus Everolimus-Eluting Metallic Stents
| Autor: | Ahmed N. Mahmoud, Islam Y. Elgendy, Ahmed Abuzaid, Amgad Mentias, Amr F. Barakat, Erik Schneibel, Akram Y. Elgendy |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Everolimus business.industry Everolimus eluting stent medicine.medical_treatment Percutaneous coronary intervention 030204 cardiovascular system & hematology Surgery law.invention 03 medical and health sciences 0302 clinical medicine Coronary thrombosis Randomized controlled trial law Meta-analysis Cardiovascular agent medicine Prosthesis design 030212 general & internal medicine Cardiology and Cardiovascular Medicine business medicine.drug |
| Zdroj: | Circulation: Cardiovascular Interventions. 10 |
| ISSN: | 1941-7632 1941-7640 |
| DOI: | 10.1161/circinterventions.117.005286 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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