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Bioresorbable vascular scaffolds versus conventional drug-eluting stents across time : a meta-analysis of randomised controlled trials
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Jackson-Smith, Elliot, Zioupos, Stephanie and Banerjee, Prithwish (2022) Bioresorbable vascular scaffolds versus conventional drug-eluting stents across time : a meta-analysis of randomised controlled trials. Open Heart, 9 (2). e002107. doi:10.1136/openhrt-2022-002107 ISSN 2053-3624.
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WRAP-bioresorbable-vascular-scaffolds-versus-conventional-drug-eluting-stents-across-time-2022.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons: Attribution-Noncommercial 4.0. Download (3309Kb) | Preview |
Official URL: http://dx.doi.org/10.1136/openhrt-2022-002107
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.
Item Type: | Journal Article | ||||||
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Subjects: | Q Science > QR Microbiology R Medicine > RC Internal medicine R Medicine > RD Surgery |
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Tissue scaffolds, Drug-eluting stents, Coronary heart disease -- Treatment | ||||||
Journal or Publication Title: | Open Heart | ||||||
Publisher: | B M J Group | ||||||
ISSN: | 2053-3624 | ||||||
Official Date: | 26 October 2022 | ||||||
Dates: |
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Volume: | 9 | ||||||
Number: | 2 | ||||||
Article Number: | e002107 | ||||||
DOI: | 10.1136/openhrt-2022-002107 | ||||||
Status: | Peer Reviewed | ||||||
Publication Status: | Published | ||||||
Access rights to Published version: | Open Access (Creative Commons) | ||||||
Date of first compliant deposit: | 21 December 2022 | ||||||
Date of first compliant Open Access: | 21 December 2022 |
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