• Meta-Analysis: BVS Not the Safest Stenting Option Stent thrombosis, MI less likely with some conventional stents at 1 year

    The Orsiro hybrid SES boasts an ultra-thin strut measuring only 61 µm and has a hybrid layer that shields against surrounding tissue after the active coating of poly-L-lactic acid breaks down.

    The authors nonetheless cautioned that “data from extended follow-up are warranted to confirm the long-term safety of contemporary coronary devices.”

    Furthermore, trials with different designs — say, for enrollment criteria and follow-up protocols — were pooled, according to Youn and colleagues.

    “As a meta-analysis of multiple trials, this study inherently shares the limitations of each trial,” they admitted. “Biodegradable polymer EES, hybrid SES, dual DES, and BVS have limited numbers of comparisons” as well, and there remain several potential sources of bias.

    Indeed, “very few randomized controlled trials of Orsiro contributed to the network meta-analysis,” Capodanno emphasized.

    The editorialist concluded that, in any case, “BMS have been perceived as the benchmark of safety for years, but latest comparative data versus DES in selected populations make it more and more difficult to find even a niche indication for these devices.”

    “Ten years ago, during the annual European Society of Cardiology meeting in Barcelona, two independent meta-analyses suggested that DES, despite being more effective than BMS in reducing restenosis, increase mortality due to very late thrombosis,” he recalled. “However, this was no longer confirmed by a plethora of randomized controlled trials and network meta-analyses, demonstrating contemporary DES to be not only safe, but even safer than BMS.”

    Disclosures

    Youn disclosed no relevant conflicts of interest.

    Capodanno reported receiving speaker’s honoraria from Abbott Vascular, AstraZeneca, Bayer, Daiichi Sankyo, Aspen, and Stentys.

    Source:

    JACC: Cardiovascular Interventions

    http://interventions.onlinejacc.org/article.aspx?articleid=2526782

    Kang S, et al “Stent thrombosis with drug-eluting stents and bioresorbable scaffolds: evidence from a network meta-analysis of 147 trials” JACC Cardiovasc Interv 2016; DOI: 10.1016/j.jcin.2016.03.038.

     

    JACC: Cardiovascular Interventions

    http://interventions.onlinejacc.org/article.aspx?articleid=2526783

    Capodanno D “Revisiting the network of drug-eluting stent trials: bioresorbable scaffolds enter the arena” JACC Cardiovasc Interv 2016; DOI: 10.1016/j.jcin.2016.04.010.

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