医学
靶病变
依维莫司
心肌梗塞
临床终点
血栓形成
内科学
冠状动脉疾病
支架
心脏病学
临床试验
生物吸附支架
不利影响
病变
血运重建
外科
经皮冠状动脉介入治疗
作者
Dean J. Kereiakes,Stephen G. Ellis,Christopher Metzger,Ronald Caputo,David G. Rizik,Paul S. Teirstein,Mortimer Litt,Annapoorna Kini,Ameer Kabour,Steven O. Marx,Jeffrey J. Popma,Robert McGreevy,Zhen Zhang,Charles A. Simonton,Gregg W. Stone
标识
DOI:10.1016/j.jacc.2017.10.010
摘要
The Absorb everolimus-eluting poly-L-lactic acid-based bioresorbable vascular scaffold (BVS) provides early drug delivery and mechanical support functions similar to metallic drug-eluting stents (DES), followed by complete bioresorption in approximately 3 years with recovery of vascular structure and function. The ABSORB III trial demonstrated noninferior rates of target lesion failure (cardiac death, target vessel myocardial infarction [TVMI], or ischemia-driven target lesion revascularization) at 1 year in 2,008 patients with coronary artery disease randomized to BVS versus cobalt-chromium everolimus-eluting stents (EES).This study sought to assess clinical outcomes through 3 years following BVS implantation.Clinical outcomes from the ABSORB III trial were analyzed by randomized treatment assignment cumulative through 3 years, and between 1 and 3 years.The primary composite endpoint of target lesion failure through 3 years occurred in 13.4% of BVS patients and 10.4% of EES patients (p = 0.06), and between 1 and 3 years in 7.0% versus 6.0% of patients, respectively (p = 0.39). TVMI through 3 years was increased with BVS (8.6% vs. 5.9%; p = 0.03), as was device thrombosis (2.3% vs. 0.7%; p = 0.01). In BVS-assigned patients, treatment of very small vessels (those with quantitatively determined reference vessel diameter <2.25 mm) was an independent predictor of 3-year TLF and scaffold thrombosis.In the ABSORB III trial, 3-year adverse event rates were higher with BVS than EES, particularly TVMI and device thrombosis. Longer-term clinical follow-up is required to determine whether bioresorption of the polymeric scaffold will influence patient prognosis. (ABSORB III Randomized Controlled Trial [RCT] [ABSORB-III]; NCT01751906).
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