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1-Year Outcomes of Everolimus-Eluting Bioresorbable Scaffolds Versus Everolimus-Eluting Stents: A Propensity-Matched Comparison of the GHOST-EU and XIENCE V USA Registries

https://doi.org/10.1016/j.jcin.2015.10.042Get rights and content
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Abstract

Objectives

The purpose of this study was to compare the 1-year outcomes of the ABSORB everolimus-eluting bioresorbable scaffold (BRS) (Abbott Vascular, Santa Clara, California) and the XIENCE everolimus-eluting stent (EES) (Abbott Vascular) in patients undergoing percutaneous coronary intervention.

Background

Randomized studies of the ABSORB BRS have been performed in selected patient and lesion scenarios. The available registries of the ABSORB BRS reflect real-world practice more closely compared with randomized studies, but most of them are limited by the small sample size and the lack of comparative outcomes versus second-generation drug-eluting stents.

Methods

A total of 1,189 consecutive patients treated with ABSORB BRS from the GHOST-EU (Gauging coronary Healing with bioresorbable Scaffolding plaTforms in EUrope) registry and 5,034 patients treated with XIENCE EES from the XIENCE V USA registry were analyzed. Clinical outcomes were compared with the use of propensity-score matching techniques and reported as Kaplan-Meier estimates and absolute risk difference (D) with 95% confidence intervals (CIs). The primary endpoint was a device-oriented composite endpoint, including cardiac death, target vessel myocardial infarction, and ischemia-driven target lesion revascularization at 1-year follow-up.

Results

After propensity score matching was performed for the entire population (N = 6,223), there were 905 matched pairs of patients. In the matched cohort (N = 1,810), there was no significant difference between ABSORB BRS and XIENCE EES in the risk of device-oriented composite endpoint at 1 year (5.8% vs. 7.6%, D = −1.8 [95% CI: −4.1 to 0.5]; p = 0.12). Cardiac death was less likely to occur in the ABSORB BRS group (0.7% vs. 1.9%, D = −1.2 [95% CI: −2.2 to 0.2]; p = 0.03), and a trend toward a reduction in myocardial infarction was noted with ABSORB BRS compared with XIENCE EES (2.4% vs. 4.0%, D = −1.6 [95% CI: −3.2 to 0.0]; p = 0.07). Conversely, no differences in ischemia-driven target lesion revascularization (4.6% vs. 3.5%, D = 1.1 [95% CI: −0.7 to 2.9]; p = 0.22) and definite or probable device thrombosis (1.8% vs. 1.1%, D = 0.7 [95% CI: −0.4 to 1.8]; p = 0.23) were detected between ABSORB BRS and XIENCE EES.

Conclusions

In a contemporary large cohort of patients undergoing percutaneous coronary intervention with ABSORB BRS, the combined rate of ischemic events at 1 year was low and nonsignificantly different compared with matched patients treated with XIENCE EES.

Key Words

bioresorbable scaffolds
drug-eluting stent(s)
propensity score

Abbreviations and Acronyms

BRS
bioresorbable scaffold(s)
DES
drug-eluting stent(s)
DOCE
device-oriented composite endpoint
EES
everolimus-eluting stent(s)
PCI
percutaneous coronary intervention

Cited by (0)

Dr. Di Mario is an investigator in the Abbott UK Registry and the EXCEL trial (grant provided to the institution). Drs. Tamburino, Capodanno, Gori, and Sabaté have received speakers honoraria from Abbott Vascular. Dr. Latib has served on the advisory board of Medtronic; and has received honoraria from Boston Scientific and Abbott Vascular. Dr. Lesiak has received research grant support, consulting, and speakers honoraria from Abbott Vascular. Dr. Nef has received speakers honoraria and an institutional research grant from Abbott Vascular. Dr. Naber has served as a speaker and advisor for Abbott Vascular. Dr. Mehilli has received lecture fees Abbott Vascular, Terumo, Edwards Lifesciences, and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.