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Professor of Medicine at Columbia University and Interventional Cardiologist and Director of Cardiovascular Research and Education at the Center for Interventional Vascular Therapy at New York Presbyterian Hospital/Columbia University Medical Center
Medical Director at The Christ Hospital Heart and Vascular Center
Director Of Interventional Cardiology, Senior Academic Officer at Cleveland Clinic Lerner College of Medicine
Associate Professor of Cardiology at University of Catania
President and Medical Director at CVPath Institute
Interventional Cardiologist at the University Hospital Clinic, Barcelona, Spain
Professor for Translational Vascular Medicine at University Medical Center Mainz
Professor of Medicine at University California, Irvine
CEO at CVPath Institute
Interventional Cardiologist, Cardiovascular Research at Fatebenefratelli Hospital
Medical Director and Chief of Cardiology, Kerckhoff Heart and Thorax Center at University of Giessen
Professor of Department of Cardiovascular Medicine at Kyoto University Graduate School of Medicine
Professor of Medicine at Columbia University Irving Medical Center
Former Abbott Vascular R&D Leader, Bioresorbable Vascular Scaffold Expert
CEO of AccelLAB; Assistant Professor Of Medicine, University Of Montreal
Professor of Medicine, Dept of Cardiology at Mount Sinai Hospital
Director of Research, Cardiac Catheterization Laboratory at New York University
Interventional Cardiology and Endovascular Specialist, Asst. Prof of Medicine Albert Einstein College of Medicine
Executive Director and Chief Scientific Officer of the CRF Skirball Research Center
Editor at Medgadget
In patients with coronary artery disease who receive metallic drug-eluting coronary stents, adverse events such as late target-lesion failure may be related in part to the persistent presence of the metallic stent frame in the coronary-vessel wall. Bioresorbable vascular scaffolds have been developed to attempt to improve long-term outcomes.
In this large, multicenter, randomized trial, 2008 patients with stable or unstable angina were randomly assigned in a 2:1 ratio to receive an everolimus-eluting bioresorbable vascular (Absorb) scaffold (1322 patients) or an everolimus-eluting cobalt–chromium (Xience) stent (686 patients). The primary end point, which was tested for both noninferiority (margin, 4.5 percentage points for the risk difference) and superiority, was target-lesion failure (cardiac death, target-vessel myocardial infarction, or ischemia-driven target-lesion revascularization) at 1 year.
Target-lesion failure at 1 year occurred in 7.8% of patients in the Absorb group and in 6.1% of patients in the Xience group (difference, 1.7 percentage points; 95% confidence interval, −0.5 to 3.9; P=0.007 for noninferiority and P=0.16 for superiority). There was no significant difference between the Absorb group and the Xience group in rates of cardiac death (0.6% and 0.1%, respectively; P=0.29), target-vessel myocardial infarction (6.0% and 4.6%, respectively; P=0.18), or ischemia-driven target-lesion revascularization (3.0% and 2.5%, respectively; P=0.50). Device thrombosis within 1 year occurred in 1.5% of patients in the Absorb group and in 0.7% of patients in the Xience group (P=0.13).
In this large-scale, randomized trial, treatment of noncomplex obstructive coronary artery disease with an everolimus-eluting bioresorbable vascular scaffold, as compared with an everolimus-eluting cobalt–chromium stent, was within the prespecified margin for noninferiority with respect to target-lesion failure at 1 year. (Funded by Abbott Vascular; ABSORB III ClinicalTrials.gov number, NCT01751906.)
All other things being equal, most of us would agree that a coronary-artery stent that disappears after its useful function has been served would be preferable to a permanently indwelling device. Late stent failure occurs at a low but steady rate with the passage of time,1 and an increasing body of evidence implicates an accelerated form of atherosclerosis inside the stent as a common underlying cause.2 Moreover, the presence of a rigid metal scaffold in the vessel wall permanently abolishes physiologic vasomotion in the stented area.
With this in mind, researchers have sought to develop self-degrading coronary stents with enough strength to produce a good short-term result and a degradation profile that results in gradual breakdown in a safe manner.3 Thus far, most success in the field has been with polylactic acid stent technology. Two such devices have received CE-mark approval, which is a prerequisite for clinical use in Europe: the everolimus-eluting Absorb bioresorbable vascular scaffold system (Abbott Vascular) in 2011 and the novolimus-eluting DESolve bioresorbable coronary scaffold system (Elixir Medical) in 2013.
Professor of Medicine at Columbia University and Interventional Cardiologist and Director of Cardiovascular Research and Education at the Center for Interventional Vascular Therapy at New York Presbyterian Hospital/Columbia University Medical Center
Medical Director at The Christ Hospital Heart and Vascular Center
Director Of Interventional Cardiology, Senior Academic Officer at Cleveland Clinic Lerner College of Medicine
Associate Professor of Cardiology at University of Catania
President and Medical Director at CVPath Institute
Interventional Cardiologist at the University Hospital Clinic, Barcelona, Spain
Professor for Translational Vascular Medicine at University Medical Center Mainz
Professor of Medicine at University California, Irvine
CEO at CVPath Institute
Interventional Cardiologist, Cardiovascular Research at Fatebenefratelli Hospital
Medical Director and Chief of Cardiology, Kerckhoff Heart and Thorax Center at University of Giessen
Professor of Department of Cardiovascular Medicine at Kyoto University Graduate School of Medicine
Professor of Medicine at Columbia University Irving Medical Center
Former Abbott Vascular R&D Leader, Bioresorbable Vascular Scaffold Expert
CEO of AccelLAB; Assistant Professor Of Medicine, University Of Montreal
Professor of Medicine, Dept of Cardiology at Mount Sinai Hospital
Director of Research, Cardiac Catheterization Laboratory at New York University
Interventional Cardiology and Endovascular Specialist, Asst. Prof of Medicine Albert Einstein College of Medicine
Executive Director and Chief Scientific Officer of the CRF Skirball Research Center
Editor at Medgadget