Long-Term Outcome of Percutaneous Coronary Intervention Using Absorb Bioresorbable Scaffold: A SCAAR Study

Background: Bioresorbable scaffolds have been associated with inferior outcomes compared to contemporary permanent metallic drug-eluting stents (DES) for percutaneous coronary intervention, particularly within the initial years after implantation; however, their long-term performance remains uncertain. This study aimed to evaluate the long-term outcomes of Swedish patients treated with Absorb bioresorbable scaffolds (Abbott) vs contemporary DES, assessing device-related complications and examining potential late benefits. The findings seek to clarify the balance between early risks and long-term advantages of bioresorbable scaffolds in clinical practice. Methods: Complete data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) was used to identify all patients receiving Absorb bioresorbable scaffolds or contemporary DES from November 4, 2011 to March 2, 2018. After 1:2 propensity score matching against modern DES, stent thrombosis, target lesion revascularization, in-stent restenosis, myocardial infarction, and all-cause mortality were analyzed. Landmark analyses were performed from 3 years onward. All patients were followed until January 17, 2022. Results: Among 1960/2406 propensity score matched patients/stents (583/802 Absorb bioresorbable scaffolds and 1377/1604 contemporary DES), bioresorbable scaffolds were associated with significantly higher early stent thrombosis, target lesion revascularization, and in-stent restenosis rates. All-cause mortality and myocardial infarction rates did not differ significantly over the entire follow-up. Beyond 3 years, the device-related outcomes converged, while myocardial infarction rates were lower with Absorb bioresorbable scaffolds than contemporary DES. Conclusions: Absorb bioresorbable scaffolds showed inferior early clinical performance compared with contemporary DES, but after 3 years, device-related outcomes were similar, while myocardial infarction rates favored Absorb bioresorbable scaffolds. These findings suggest a complex trade-off between early device-related events and potential long-term benefits of bioresorbable scaffold-mediated vascular restoration.