Monday, September 15, 2014

THE ABSORB STENT. WILL IT LIVE UP TO EXPECTATION?

In the field of interventional cardiology ( which is plateauing ), obviously the latest stent impacting us is the Absorb bioresorbable vascular scaffolding, which reach our Malaysian shores about 4-5 years ago. Of course the initial results were excellent, Absorb cohort A, Absorb cohort B, ABSORB I trial ( we are awaiting the 5 year follow-up results ) and the ABSORB II study, the prelim 1 year FU data was just released by Patrick Serruys at TCT. From the CV, looks like Patrick, the cornerstone of ThoraxCenter, Rotterdam, for so many years, have now moved to Imperial College, London ( need to check this out ). Well, Patrick released the Absorb II interim analysis and showed that the Absorb was as good as the good "old" Xience V ( good DES ), except for some less acute lumen gain. That is a minor point according to Patrick but I think that that point cannot be simply dismissed.
Anyway, between Absorb I and Absorb II, investigators ( not from the Patrick group ), the other European investigators have published the GHOST-EU registry at Eurointervention 2014. Led by Dr Capodanno, these investigators publish their registry of 1,189 patients, across 10 European Centers,  who had the Absorb bio-resorbable vascular scaffolding implanted between Nov 2011 - January 2014 ), and followed up. This seemed more real world, when compared to the "mastery" skills of Patrick and team. They found that there were significant problems. Over follow up of 6 months, there were 2.1% stent thrombosis, death rate 1.0%, target lesion MI of 2.0% and TLR of 2.5%. TVR was 4.0%. These are not small numbers. And it is only 6 months.
Of course, I have always shy away from using Absorb because Abbott Vascular's Xience Prime was working excellent in my hands and not to forget, the Xience Prime DES was much cheaper, making it more cost effective ( value for money ), except that this Xience Prime cannot disappear.
Looks like Absorb is a good stent but there are still issues to be resolved. Xience Prime is a very good stent and is much cheaper.
I hear that there is a company call Elixir, who also has a bio-resorbable vascular scaffolding. The drug is different,another -limus, called novolimus. So competition is on the way. Looks like prices will becoming down.

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