Deutsches Herzzentrum München, Technische Universität München, Germany.
DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
Eur Heart J. 2018 May 7;39(18):1591-1601. doi: 10.1093/eurheartj/ehx488.
A previous Task Force of the European Society of Cardiology (ESC) and European Association of Percutaneous Cardiovascular Interventions (EAPCI) provided a report on recommendations for the non-clinical and clinical evaluation of coronary stents. Following dialogue with the European Commission, the Task Force was asked to prepare an additional report on the class of devices known as bioresorbable scaffolds (BRS). Five BRS have CE-mark approval for use in Europe. Only one device-the Absorb bioresorbable vascular scaffold-has published randomized clinical trial data and this data show inferior outcomes to conventional drug-eluting stents (DES) at 2-3 years. For this reason, at present BRS should not be preferred to conventional DES in clinical practice. The Task Force recommends that new BRS devices should undergo systematic non-clinical testing according to standardized criteria prior to evaluation in clinical studies. A clinical evaluation plan should include data from a medium sized, randomized trial against DES powered for a surrogate end point of clinical efficacy. Manufacturers of successful devices receive CE-mark approval for use and must have an approved plan for a large-scale randomized clinical trial with planned long-term follow-up.
欧洲心脏病学会(ESC)和欧洲经皮心血管介入学会(EAPCI)的前一个工作组就冠状动脉支架的非临床和临床评估提供了一份报告。在与欧盟委员会进行对话后,工作组被要求就所谓的生物可吸收支架(BRS)类设备编写一份补充报告。五种 BRS 已获得 CE 标志批准在欧洲使用。只有一种设备——Absorb 生物可吸收血管支架——公布了随机临床试验数据,这些数据显示在 2-3 年内,BRS 的结果不如传统的药物洗脱支架(DES)。因此,目前在临床实践中,BRS 不应优先于传统的 DES。工作组建议,新的 BRS 设备应根据标准化标准进行系统的非临床测试,然后再在临床研究中进行评估。临床评估计划应包括来自与 DES 进行的中等规模、随机试验的数据,DES 的效力为临床疗效的替代终点。成功的设备制造商将获得 CE 标志批准,并必须有一项经批准的大型随机临床试验计划,并计划进行长期随访。