Efficacy and Safety of Bioresorbable Vascular Scaffolds Versus Contemporary Drug-Eluting Stents in Coronary Artery Disease: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis
- 1Interventional Center of Valve Heart Disease, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China
Abstract
Background:: Bioresorbable vascular scaffolds (BVS) were developed to address some limitations associated with permanent metallic drug-eluting stents (DES), but the comparative safety and efficacy of these scaffolds remain uncertain.
Methods:: We conducted a systematic review and meta-analysis of randomized and observational studies comparing BVS with contemporary DES in patients with coronary artery disease. The primary outcome was the composite clinical endpoint at 1-year. Secondary outcomes included mortality, myocardial infarction (MI), revascularization, thrombosis, and angiographic measures. Outcomes at 2, 3, and 5 years were analyzed separately. Trial sequential analysis (TSA) was used to assess the robustness of the evidence for the primary outcome.
Results:: A total of 51 studies (69 reports) were included. At 1 year, BVS was associated with a higher risk of the composite clinical endpoint than DES (risk ratio (RR) 1.11, 95% confidence interval (CI 1.00–1.22)), mainly driven by increased risks of MI, target lesion revascularization, and thrombosis. In contrast, all-cause and cardiac mortality did not differ significantly between groups. TSA showed that although the cumulative Z-curve reached the required information size, the Z-score did not cross the trial sequential monitoring boundary, indicating that the evidence for the primary endpoint remained inconclusive. During mid- and long-term follow-up, BVS remained associated with higher risks of ischemic events and repeat revascularization, without a survival benefit. Angiographic analyses showed greater late lumen loss, smaller minimal lumen diameter, and greater diameter stenosis with BVS.
Conclusions:: Compared with contemporary DES, BVS appears to confer a higher ischemic risk without a long-term mortality benefit. Contemporary DES remains the preferred revascularization strategy.
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BibTeX
@article{yu2026efficacy,
title = {{Efficacy and Safety of Bioresorbable Vascular Scaffolds Versus Contemporary Drug-Eluting Stents in Coronary Artery Disease: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis}},
author = {Yue Yu and Ke Shang and Yuemiao Jiao and Sanshuai Chang and Yang Li and Guangyuan Song and Chengqian Yin},
journal = {Reviews in Cardiovascular Medicine},
year = {2026},
month = oct,
doi = {10.31083/rcm51636},
url = {https://doi.org/10.31083/rcm51636},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Efficacy and Safety of Bioresorbable Vascular Scaffolds Versus Contemporary Drug-Eluting Stents in Coronary Artery Disease: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis
AU - Yue Yu
AU - Ke Shang
AU - Yuemiao Jiao
AU - Sanshuai Chang
AU - Yang Li
AU - Guangyuan Song
AU - Chengqian Yin
PY - 2026
DA - 2026/10/20
JO - Reviews in Cardiovascular Medicine
DO - 10.31083/rcm51636
UR - https://doi.org/10.31083/rcm51636
AB - Background:: Bioresorbable vascular scaffolds (BVS) were developed to address some limitations associated with permanent metallic drug-eluting stents (DES), but the comparative safety and efficacy of these scaffolds remain uncertain. Methods:: We conducted a systematic review and meta-analysis of randomized and observational studies comparing BVS with contemporary DES in patients with coronary artery disease. The primary outcome was the composite clinical endpoint at 1-year. Secondary outcomes included mortality, myocardial infarction (MI), revascularization, thrombosis, and angiographic measures. Outcomes at 2, 3, and 5 years were analyzed separately. Trial sequential analysis (TSA) was used to assess the robustness of the evidence for the primary outcome. Results:: A total of 51 studies (69 reports) were included. At 1 year, BVS was associated with a higher risk of the composite clinical endpoint than DES (risk ratio (RR) 1.11, 95% confidence interval (CI 1.00–1.22)), mainly driven by increased risks of MI, target lesion revascularization, and thrombosis. In contrast, all-cause and cardiac mortality did not differ significantly between groups. TSA showed that although the cumulative Z-curve reached the required information size, the Z-score did not cross the trial sequential monitoring boundary, indicating that the evidence for the primary endpoint remained inconclusive. During mid- and long-term follow-up, BVS remained associated with higher risks of ischemic events and repeat revascularization, without a survival benefit. Angiographic analyses showed greater late lumen loss, smaller minimal lumen diameter, and greater diameter stenosis with BVS. Conclusions:: Compared with contemporary DES, BVS appears to confer a higher ischemic risk without a long-term mortality benefit. Contemporary DES remains the preferred revascularization strategy.
SN - 1530-6550
SN - 2153-8174
ER -