Bioresorbable vascular scaffold during ST-elevation myocardial infarction (STEMI): A Systematic Review

Abstract Background Bioresorbable vascular scaffolds (BVS) represent a novel technology designed to overcome the long-term limitations of metallic coronary stent implantation in percutaneous coronary intervention (PCI). In this context, primary PCI in ST-elevation myocardial infarction (STEMI) could be a preferred scenario for BVS implantation. Nevertheless, data on efficacy and safety is lacking in this specific subset of patients. Methods We conducted a systematic review to examine the safety and efficacy of BVS in STEMI patients. We searched PubMed, EMBASE, and the Cochrane Library through June 2016 for studies that included outcome data for BVS implantation in STEMI patients. Outcomes of interest included cardiac death, myocardial infarction, scaffold thrombosis (ST), target lesion revascularization, restenosis, and composite endpoints. Results We identified nine eligible articles, which included one randomized controlled trial (RCT) and eight cohort studies (five controlled), for a total of 846 patients. These studies varied in size (11 to 290) and follow-up duration (1 to 24 months). The incidence of major cardiac events ranged from 1.1% to 13%, with no statistically significant difference between BVS and control in studies that included a comparison group. While there was a trend toward an increase in scaffold thrombosis in the largest controlled registries, no statistically significant increase was found. Conclusion Current clinical data are scarce, but suggest that BVS may represent a reasonable alternative to drug-eluting stents in STEMI patients. The lack of large RCTs with extended follow-up periods and the ST signal are limiting factors for widespread use before additional large-scale trials are available.