Steroids for the Prevention of Restenosis in Bare-Metal Stents - A Systematic Review and Meta-Analysis

Introduction. Stent restenosis remains a common complication of bare-metal stent (BMS) implantation. Even in the drug-eluting stent (DES) era, there remains a significant proportion of patients who may not be eligible for DES due to inability to comply with prolonged dual antiplatelet therapy. We reviewed the validity of empirical evidence that periprocedural treatment with steroids at the time of insertion of a BMS may delay restenosis and provide benefit through reductions in adverse clinical events. Methods. We searched the PubMed, EMBASE and Cochrane Central Register of Controlled Trials databases for randomized controlled trials conducted between 1990 and 2011 that assessed the impact of systemic steroid administration within 72 hours to 7 days of angioplasty alone and BMS placement. The comparator included standard medical therapy and/or placebo. Outcomes assessed were: (1) rates of restenosis at the end of at least 6 months of follow-up; (2) rates of target vessel revascularization; and (3) risk of all-cause mortality. The methodological quality of the studies was assessed, as was publication bias. Relative risk of restenosis, revascularization, and rates of in-hospital mortality for treatment and control groups were compared using a random effects model (Mantel-Haenszel). Results. We identified 5 studies that met inclusion criteria. No significant reduction in restenosis rates was observed after angioplasty alone with steroids. However, with BMS, significant reductions in restenosis rates (relative risk [RR], 0.60; 95% confidence interval [CI], 0.37-0.97; P=.04), and target vessel revascularization rates (RR, 0.56; 95% CI, 0.34-0.92; P=.02) were observed in the steroid-treated group. A 28% mortality reduction was observed with steroid treatment with BMS placement, but was not statistically significant. Conclusion. Periprocedural steroid administration during BMS implantation may reduce rates of restenosis and target vessel revascularization, without adverse clinical effects attributable to steroid use.