Drug-Eluting Versus Bare Metal Stents in Saphenous Vein Graft Intervention: An Updated Comprehensive Meta-Analysis of Randomized Trials |
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| Institution: | 1. Division of Cardiology, Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA;2. Vanderbilt University Medical Center, Nashville, TN, USA;3. VA North Texas Health Care System, University of Texas Southwestern Medical Center at Dallas, TX, USA;4. Minneapolis Heart Institute, Minneapolis, MN, USA;5. Division of Cardiology, Department of Internal Medicine, Texas Tech University, TX, USA;6. Emory University School of Medicine, Atlanta VA Medical Center, Atlanta, GA, USA;7. University of Arizona College of Medicine, Tucson, AZ, USA;1. The Queen''s Medical Center, Honolulu, HI, USA;2. University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA;3. Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand;4. Department of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA;5. Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA;6. Department of Pathology, Duke University Medical Center, Durham, NC, USA;1. Department of Cardiology, Prince of Wales Hospital, Sydney, NSW, Australia;2. Keele Cardiovascular Research Group, University of Keele, and Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK;3. Faculty of Medicine, University of Southampton, UK;4. HeartFlow, Redwood City, CA, USA;5. University Hospital Southampton NHS Foundation Trust, UK;1. Department of Internal Medicine, Hurley Medical Center/Michigan State University, Flint, MI 48503, USA;2. Department of Internal Medicine, Mutah University, Al-Karak, Jordan;3. Department of Internal Medicine, Saint Agnes Hospital, Baltimore, MD 21229, USA;4. Division of Cardiology, Hurley Medical Center/Michigan State University, Flint, MI 48503, USA;1. Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA;2. Department of Cardiovascular Medicine, Hennepin Healthcare, Minneapolis, MN, USA;3. Department of Medicine, Mercy Hospital and Medical Center, Chicago, IL, USA;4. Department of Medicine, Ascension St John Hospital, Detroit, MI, USA;5. Department of Medicine, University at Buffalo, Buffalo, NY, USA;6. Department of Medicine, Steward Carney Hospital, Dorchester, MA, USA;7. Ain Shams University, Faculty of Medicine, Cairo, Egypt;8. Division of Cardiology, Ain Shams University, Cairo, Egypt;9. Division of Cardiology, Department of Medicine, University of Texas Medical Branch, Galveston, TX, USA;10. Division of Cardiology, Department of Medicine, Saint Luke''s Hospital, Kansas City, MO, USA;11. Division of Cardiology, Department of Medicine, University of Arkansas, Little Rock, AR, USA;1. Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA;2. Division of Cardiology, Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA;1. Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain;2. Medical Department Astrazeneca, Spain;3. Biochemistry Department, Faculty of Medicine, Universidad Autónoma, Madrid, Spain;4. Department of Medicine, Division of Cardiology, Montefiore Medical Center, New York, USA;5. i?+?12 Research Institute and Cardiology Department, Hospital 12 de Octubre, Madrid, Spain;6. Spanish National Centre for Cardiovascular Research (CNIC), Madrid, Spain;7. Faculty of Medicine, Universidad Complutense de Madrid, Spain;8. Cardiology Department, Hospital Virgen del Mar, Madrid, Spain;9. Biostatistics, Leon University, León, Spain;10. Department of Anesthesiology and Cardiology, Mayo Clinic, Phoenix, USA |
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| Abstract: | BackgroundDrug eluting stents (DES) are preferred over bare metal stents (BMS) for native coronary artery revascularization unless contraindicated. However, the preferred stent choice for saphenous venous graft (SVG) percutaneous coronary interventions (PCI) is unclear due to conflicting results.MethodsPubMed, Clinical trials registry and the Cochrane Center Register of Controlled Trials were searched through June 2018. Seven studies (n = 1639) comparing DES versus BMS in SVG-PCI were included. Endpoints were major adverse cardiac events (MACE), cardiovascular mortality, all-cause mortality, myocardial infarction (MI), target vessel revascularization (TVR), target lesion revascularization (TLR), in-stent thrombosis, binary in-stent restenosis, and late lumen loss (LLL).ResultsOverall, during a mean follow up of 32.1 months, there was no significant difference in the risk of MACE, cardiovascular mortality, all-cause mortality, MI, stent thrombosis, TVR and TLR between DES and BMS. However, short-term follow up (mean 11 months) showed lower rate of MACE (OR 0.66 0.51, 0.85]; p = 0.002), TVR (OR 0.47 0.23, 0.97]; p = 0.04) and binary in-stent restenosis (OR 0.14 0.06, 0.37]; p < 0.0001) in DES as compared with BMS. This benefit was lost on long-term follow up with a mean follow up 35.5 months.ConclusionIn this meta-analysis of SVG-PCI, DES use was associated with similar MACE, cardiovascular mortality, all-cause mortality, MI, in-stent thrombosis, TVR and TLR compared with BMS during long-term follow up. There was high incidence of MACE noted in both DES and BMS suggesting a need for exploring novel strategies to treat SVG disease to improve clinical outcomes. |
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