Mid-to-long term clinical outcomes with everolimus-eluting bioresorbable vascular scaffold versus everolimus-eluting metallic stent in coronary artery diseases: a meta-analysis of 7321 patients

AIM To compare the mid-to-long term clinical outcomes between everolimus-eluting bioresorbable vascular scaffolds (BVS) and everolimus-eluting metallic stent (EES) in coronary artery diseases. METHODS The present investigation systematically searched electronic databases and abstracts or presentations from the latest international cardiovascular conferences up to January 8th 2018. RESULTS In total, 11 studies with 7321 patients were enrolled, including 7 randomized controlled trials and 4 propensity score-matched designs. Pooled analysis revealed that the patients undergoing 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 related 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. Myocardial infarction increased in 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 is associated with compromised clinical outcomes. Additional clinical outcomes of long-term large-scale clinical trials are warranted to further evaluate the use of BVS.