Meta-analysis finds higher target-lesion revascularization with Magmaris scaffold vs. DES in ACS
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Key Takeaway
Consider that Magmaris shows higher target-lesion revascularization vs. DES; comparative efficacy remains uncertain due to limited evidence.
This systematic review and meta-analysis evaluated the Magmaris bioresorbable magnesium scaffold versus drug-eluting stents (DES) in patients with acute coronary syndrome undergoing percutaneous coronary intervention. The pairwise analysis included 622 patients (322 Magmaris, 300 DES), with an additional 1,391 patients in single-arm analyses. Follow-up was one year.
The primary outcome, target-lesion failure (composite of cardiac death, target-vessel myocardial infarction, and target-lesion revascularization), showed no statistically significant difference between groups (OR 1.53; 95% CI 0.79–2.97; p=0.21; 7.5% vs. 5.3%). However, target-lesion revascularization was significantly higher with Magmaris (OR 2.63; 95% CI 1.17–5.90; p=0.019; 6.8% vs. 3.0%). No significant differences were observed for target-vessel myocardial infarction, cardiac death, or scaffold/stent thrombosis. The pooled 1-year incidence of scaffold/stent thrombosis was 0.83%. Procedural success was high at 98.49% (95% CI 97.21–99.18).
The authors note several limitations: limited and heterogeneous evidence, wide confidence intervals, and a small number of included studies. The meta-analysis includes both observational and randomized studies, so findings represent associations only. Certainty is low.
In practice, Magmaris in ACS was associated with low observed stent thrombosis rates, but comparative safety and efficacy versus DES remain uncertain. The higher target-lesion revascularization rates suggest technical improvements are needed before it can be considered a robust alternative.
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View Original Abstract ↓
BackgroundBioresorbable scaffolds aim to mitigate long-term complications of drug-eluting stents (DES). The bioresorbable magnesium scaffold Magmaris is an alternative, but its role in acute coronary syndrome (ACS) remains insufficiently studied. Therefore, we aimed to evaluate safety and efficacy of Magmaris in ACS and compare outcomes with DES.MethodsWe systematically searched PubMed, Embase and Cochrane Central Register of Controlled Trials for randomized and observational studies reporting outcomes of Magmaris in ACS. Primary outcome was target-lesion failure (TLF) defined as composite of cardiac death (CD), target-vessel myocardial infarction (TV-MI) and target-lesion revascularization (TLR) at one year. Secondary outcomes included scaffold/stent thrombosis (ST) and procedural success. Single-arm pooled event rates and pairwise comparisons were estimated using generalized linear mixed-effects models (GLMM).ResultsWe included four studies (n = 622 patients; 322 Magmaris, 300 DES) for pairwise analysis. At one year, no statistically significant difference in TLF was observed between Magmaris and DES (7.5% vs. 5.3%, OR 1.53, 95% CI 0.79–2.97; p = 0.21; I2 = 54.7%), although confidence intervals were wide. TLR was significantly higher with Magmaris (6.8% vs. 3.0%, OR 2.63, 95% CI 1.17–5.90; p = 0.019; I2 = 10.7%), while TV-MI, CD and ST did not differ significantly between groups. Twelve studies (n = 1,391 patients) contributed single-arm analyses showing pooled 1-year incidence of TLF 4.97%, TLR 4.16% and ST 0.83%. Procedural success was 98.49% (95% CI 97.21–99.18; I2 = 35.4%).ConclusionIn ACS, Magmaris was associated with low observed ST rates, nevertheless, comparative safety and efficacy vs. DES remain uncertain due to limited and heterogeneous evidence. Higher TLR rates with Magmaris suggest that further technical improvements in next-generation magnesium scaffolds are needed before this strategy can be considered a robust alternative in ACS.
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