Three-year outcome of everolimus-eluting bioresorbable vascular scaffold versus everolimus-eluting metallic stents: a comprehensive updated meta-analysis of randomized controlled trials

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.

KEYWORDS:

• Ischemia driven target lesion revascularization
• patient-oriented composite endpoints
• device-oriented composite endpoints
• ischemia
• revascularization
• everolimus
• bioresorbable stent
• metallic stent

Highlight box

1. In recent years, everolimus-eluting bioresorbable vascular scaffolds (EE-BRSs) have been developed as an alternative to everolimus-eluting metallic stents (EESs) to treat coronary artery disease.

2. Previous studies reported a high thrombosis incidence after EE-BRS treatment.

3. The results of this study showed no inferiority of EE-BRS vs EES, 1-year and 2-years after interventions regarding efficacy.

4. There was a significant difference regarding thrombosis between EE-BRS and EES in the 1-year and 2-year follow-ups.

5. After 3-years follow-up, there was no significant difference in the risk for thrombosis in the EE-BRS and EES intervention patients.

Authors‘ contributions

HZ, JZ, ZL, RG, and YW were responsible for the conception and design of the study. HZ, JZ, YX, WZ, YS, QL, and YW were responsible for acquisition and analysis of data; furthermore, HZ, JZ, YX, YS, and QL were in charge of statistical analysis. HZ, JZ, WZ, YW, and YW drafted the manuscript; HZ, JZ, ZL, RG, and YW revised and commented the draft. All the authors approved the final version of the manuscript.

Availability of data and material

The dataset supporting the conclusions of this article is included within the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.