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This study was aimed at investigating the long-term safety and efficacy of the Absorb Bioresorbable Vascular ScaffoldTM (BVS), drug-eluting stents (DES), and bare metal stents (BMS).
Randomized controlled trials that compared 2 or more coronary stents or scaffolds and reported long-term clinical outcomes were included. Electronic search was done in PubMed, Embase, Cochrane Central Register of Controlled Trials, and relevant websites.
A total of 91 randomized controlled trials that compared 2 or more coronary stents or scaffolds and reported long-term clinical outcomes (≥2 years) comprising 105,842 patients were analyzed (mean follow-up, 3.7 years). Network meta-analysis showed that BVS had a significantly higher risk of definite or probable stent thrombosis (ST) than contemporary DES. The risk of very late ST was highest with the Absorb BVS among comparators. Pairwise conventional meta-analysis showed the elevated risk of ST with BVS compared to cobalt chromium everolimus-eluting stent was consistent across onset time such as early (≤ 30 days), late (31 days - 1 year), and very late ST (>1 year) period. Furthermore, significantly higher risk of target lesion failure was observed with BVS, which was driven by both increased risk of target-vessel-myocardial infarction and ischemia-driven target-lesion revascularization.
Implantation of Absorb BVS was associated with increased risk of long-term and very late ST compared to current-generation metallic DES, and the risk of scaffold thrombosis appeared to have a rising trend beyond 1 year.