Key result
Absorb scaffolds match XIENCE for TVF across SYNTAX tertiles but increase device thrombosis in complex lesions.
Why the study?
The impact of coronary disease complexity assessed by SYNTAX score on clinical outcomes comparing bioresorbable vascular scaffolds versus everolimus-eluting stents was unclear.
Does bioresorbable vascular scaffold (Absorb) reduce target vessel failure compared to everolimus-eluting stent (XIENCE) across different levels of coronary complexity?
RCT (n=1,661)
Does bioresorbable vascular scaffold (Absorb) reduce target vessel failure compared to everolimus-eluting stent (XIENCE) across different levels of coronary complexity?
Bioresorbable vascular scaffolds are associated with an increased risk of device thrombosis compared to everolimus-eluting stents in patients with moderate to high coronary complexity.
Higher thrombosis risk with Absorb in complex lesions warrants caution; leaves open any scaffold advantage in low-SYNTAX subsets.
AIMS: We aimed to evaluate the impact of the complexity of coronary disease as assessed by the SYNTAX score (SXscore) on the clinical outcomes in the AIDA trial. METHODS AND RESULTS: In the AIDA trial, we compared Absorb versus XIENCE in routine clinical practice. Clinical outcomes were stratified by SXscore tertiles: SXlow (SXscore ≤8), SXmid (SXscore >8 and ≤15) and SXhigh (>15). The SXscore was available in 1,661 of the 1,845 (90%) patients. The event rate of TVF was numerically lower in Absorb compared to XIENCE (3.7% versus 5.6%; p=0.257) in the SXlow tertile, numerically higher in Absorb in the SXmid tertile (11.4% versus 9.3%, p=0.421) and similar in the SXhigh tertile (15.5% versus 15.6%; p=0.960). The rates of definite/probable device thrombosis in Absorb versus XIENCE were significantly higher in the SXmid tertile (3.3% versus 0.8%, p=0.043) and in the SXhigh tertile (3.7% versus 0.8%, p=0.006). CONCLUSIONS: We found no significantly different rates of TVF between Absorb and XIENCE patients. Absorb-treated patients in the SXmid and SXhigh tertiles had an increased risk of device thrombosis when compared to XIENCE-treated patients. The rates of device thrombosis in the SXlow tertile, while still higher for Absorb, are more acceptable than in the SXmid and SXhigh score tertiles.
No takes yet. Share an insight, caveat, or question.
Kraak et al. (2020) conducted an RCT in Coronary disease (n=1,661). Absorb bioresorbable vascular scaffold vs. XIENCE everolimus-eluting stent was evaluated on Target vessel failure (TVF). Absorb scaffolds showed similar target vessel failure rates to XIENCE stents across SYNTAX score tertiles, but significantly increased device thrombosis in mid and high complexity lesions.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: