Everolimus-eluting bioabsorbable vascular scaffolds (BVS) versus everolimus-eluting metallic stents (EES) at 3 years : systematic review and meta-analysis

BACKGROUND: This systematic review and meta‐analysis aimed to assess the efficacy and safety of the Absorb bioabsorbable vascular scaffold (BVS) versus everolimus‐ eluting metallic stents (EES) at 3 years. METHODS: We searched MEDLINE, EMBASE, CENTRAL and relevant websites for articles published between 30 November 2006 and 18 December 2017. The primary efficacy outcome was target lesion revascularization (TLR), and the primary safety outcome was definite or probable stent (scaffold) thrombosis. Secondary outcomes included target lesion failure, myocardial infarction (MI), death, all revascularization and a patient‐oriented composite end‐point. We derived odds ratios (ORs) for the outcomes according to a fixed‐effects model. This study was registered with PROSPERO (CRD42017084290). Results: We included five trials comprising data for 3,575 patients randomized to re‐ ceive BVS (n = 2,256) or EES (n = 1,319). Patients treated with the BVS had a non‐statistically significant increased risk of TLR (OR 1.30 [95% CI 0.95–1.78]; p = 0.10). Patients treated with the BVS had a higher risk of definite or probable stent thrombosis (OR 2.68 [95% CI 1.57–4.58]; p < 0.001), target lesion failure (1.41 [1.12–1.78]; p = 0.004), MI (1.49 [1.13–1.98]; p = 0.005) and a patient‐oriented composite end‐point (1.21 [1.01– 1.44]; p = 0.038) than those treated with an EES. Patients treated with the BVS had no statistically significant difference in death (0.80 [0.51–1.25]; p = 0.325) and all revascu‐ larization (1.12 [0.91–1.40]; p = 0.052) compared to those treated with an EES. CONCLUSION: Everolimus‐eluting bioabsorbable vascular scaffolds are inferior to everolimus‐eluting metallic stents at 3 years.