Meta-analysis comparing sirolimus bioresorbable scaffolds versus everolimus-eluting metallic stents in coronary arterial disease

Abstract

Abstract Introduction In the acute setting, thin-strut bioresorbable scaffolds (BRS) are noninferior versus the thin-strut drug-eluting stent. Recently, randomized controlled trials (RCTs) with long-term follow-up data have been published. Purpose To evaluate the long-term clinical outcomes of sirolimus BRS versus the benchmark everolimus DES. Methods We reviewed the literature and conducted a meta-analysis of all RCTs comparing sirolimus BRS versus metallic DES stents in patients with CAD. The primary outcomes were all-cause mortality and target vessel failure (TVF). Furthermore, secondary outcomes included cardiac mortality, target vessel myocardial infarction, ischemia-driven target lesion revascularization (TLR), and stent thrombosis (probable and definite). Statistical analysis was conducted using Review Manager 5.4. Two-sided p values of <0.05 were considered as statistical significance. Results A total of 15,930 patients were included with a median-weighted follow up period of 1.68 years. Heterogeneity was low-high across the trials (0–87%). All-cause mortality was insignificant between the two groups (OR 0.95; 95% CI 0.79–1.14; p=0.57) (Figure 1). The rate of TVF showed a trend favoring sirolimus BRS compared to everolimus DES with statistical significance (OR 0.84; 95% CI 0.73–0.98; p=0.02) (Figure 1). Ischemia-driven TLR also statistically favored sirolimus BRS (OR 0.64; 95% CI 0.53–0.77; p<0.ehab724.12301) (Figure 2). Otherwise, all other secondary outcomes favored sirolimus BRS without statistical significance (Figure 2). Conclusion This updated meta-analysis illustrates that in the long term setting sirolimus BRS has significantly decreased rate of TVF and ischemia-driven TLR as compared to everolimus DES. However, there was no statistical difference in the all-cause mortality or cardiac mortality. Funding Acknowledgement Type of funding sources: None.