A Meta-Analysis Of Clinical Outcomes With Everolimus-Eluting Bioresorbable Vascular Scaffold Versus Drug-Eluting Metallic Stent In Coronary Artery Diseases

Background:Recent studies raised several concerns about the safety and efficacy of bioresorbable vascular scaffold(BVS).We performed the meta-analysis to compare the mid-to-long term clinical outcomes between BVS and everolimus-eluting metallic stent(EES)in coronary artery diseases,aiming to provide the conference for clinical decision-making.Methods:We systematically searched electronic databases and abstracts or presentations from latest international cardiovascular conferences by January 8th 2018.Results:In total,11 studies with 7321 patients were enrolled,including 7 randomized controlled trials(RCTs)and 4 propensity score-matched designs.Pooled analysis revealed that patients underwent BVS implantation had a higher rate of definite or probable stent/scaffold thrombosis(ST)(odds ratio(OR)=3.08,95%confidence interval(CI):2.04 to 4.66,P<0.01),which was mainly attributed to the higher risks of early ST(OR=2.26,95%CI:1.26 to 4.03,P=0.006)and very late ST(OR=4.46,95%CI:2.01 to 9.89,P<0.01).Also,target-lesion failure(TLF)was more frequent in BVS(OR=1.34,95%CI:1.11 to 1.60,P=0.002),which was due to the higher rates of target vessel myocardial infarction(OR=1.71,95%CI:1.31 to 2.23,P<0.01)and ischemia driven-target lesion revascularization(OR=1.51,95%CI:1.15 to 2.00,P=0.004)accompanied with BVS implantation.All myocardial infarction was increased with BVS compared with EES(OR=1.52,95%CI:1.22 to 1.90,P<0.01),but there were no significant differences in patient-oriented composite endpoint,all death and all revascularization between BVS and EES.Conclusion:Our meta-analysis demonstrated that,compared with EES,BVS was associated with compromised clinical outcomes.But more clinical outcomes of long-term large-scale clinical trials are needed to evaluate the use of BVS.