BONITO Registry Compares Bioresorbable Scaffolds Versus Drug-Eluting Stents in CTOs

October 11, 2016—Findings from the BONITO registry comparing procedural and long-term outcomes for bioresorbable scaffolds (BRSs) versus drug-eluting stents (DESs) in chronic total occlusions (CTOs) were published online ahead of print by Lorenzo Azzalini, MD, et al in Circulation: Cardiovascular Interventions.

In the background to the study, the investigators noted that there is little evidence regarding the efficacy and safety of BRSs for the percutaneous treatment of CTOs.

The multicenter registry was composed of consecutive CTO patients treated with a BRS (Absorb, Abbott Vascular) and second-generation DESs at five institutions. The primary endpoint was long-term arget vessel failure (TVF; a composite of cardiac death, target vessel myocardial infarction, and ischemia-driven target-lesion revascularization [TLR]).

As summarized in Circulation: Cardiovascular Interventions, inverse probability of treatment weight-adjusted Cox regression was used to account for pretreatment differences between the two groups. A total of 537 patients (n = 153 BRS; n = 384 DES) were included. BRS patients were younger and had a lower prevalence of comorbidities. The overall mean Japan-CTO score was 1.43 ± 1.16, with no differences between groups.

The investigators reported that procedural success was achieved in 99.3% and 96.6% of BRS- and DES-treated patients, respectively (P = .07). At a median follow-up of 703 days, there were no differences in TVF between the BRS and DES groups (4.6% vs 7.7%; P = .21). By adjusted Cox regression analysis, there were still no significant differences between the BRS and DES groups (hazard ratio, 1.54; 95% confidence interval, 0.69–3.72; P = .34). However, secondary analyses suggested a signal toward higher ischemia-driven TLR with BRS treatment.

The investigators concluded that implantation of BRSs versus second-generation DESs in CTOs was associated with similar risk of TVF at long-term follow-up; however, a signal toward increased ischemia-driven TLR with BRSs was observed. Large randomized studies are needed to confirm these findings, noted the investigators in Circulation: Cardiovascular Interventions.