Author + information
- Felix Valencia-Serrano1
It is controversial whether the risks associated with bioresorbable drug eluting stents (bDES) are related with device characteristics or implantation technique.
To compare the risks associated with bDES versus metallic drug eluting stents (mDES) and to determine the impact of implantation technique on long-term clinical outcomes a systematic review of randomized clinical trials comparing bDES vs mDES was performed. Pooled relative risks of death, myocardial infarction, the need of further revascularization and stent thrombosis were estimated in random-effects meta-analysis. Stratified analysis were performed according to a per-protocol bDES dedicated implantation technique or not and to the presence or not of significant differences in device post-dilatation among groups.
7 randomized clinical trials were identified including 4020 patients (2439 randomized to bDES and 1581 to mDES). bDES was associated with increased risks of myocardial infarction (RR= 1.46, 95%CI 1.06-1.93), clinically indicated target lesion revascularization (RR= 1.60, 95%CI 1.10-2.31) and stent thrombosis (RR = 2.52, 95%CI 1.26-5.05,). Both a per-protocol bDES dedicated implantation technique and higher rates of postdilatation were associated with a reduction in the magnitude of these associations, but not in its direction.
A dedicated implantation technique improves clinical outcomes associated with the use of bDES. Both device characteristics and implantation technique seem to contribute to the risks associated with bDES.
CORONARY: Stents: Bioresorbable Vascular Scaffolds