Drug-Eluting Stents Versus Bare-Metal Stents in Saphenous Vein Graft Interventions A Systematic Review and Meta-Analysis

Objectives We sought to review the published data and perform a meta-analysis to reach robust conclusions in the comparison between bare-metal stents (BMS) and drug-eluting stents (DES) in saphenous vein graft (SVG) percutaneous coronary interventions (PCIs). Background Drug-eluting stents are superior to BMS in reducing major adverse cardiac events (MACE) after PCI in native coronary arteries. However, studies comparing BMS with DES in PCI of SVG have had mixed results, probably due to smaller numbers and the nonrandomized nature of most of them. Methods The published reports search identified 4 randomized controlled trials and 19 cohort studies comparing BMS with DES in SVG interventions. Clinical end point data were abstracted and analyzed in aggregate and in subgroup analyses with random-effects model. Results Patients receiving DES had a lower risk of mortality (odds ratio [Or] 0.75; confidence interval [CI]: 0.59 to 0.96), target lesion revascularization (TLR) (OR: 0.57; CI: 0.40 to 0.82), target vessel revascularization (TVR) (OR: 0.56; CI: 0.40 to 0.77), and MACE (OR: 0.61; CI: 0.42 to 0.79). Drug-eluting stent use resulted in a significant absolute risk reduction in TLR (-0.07; CI: -0.11 to -0.03), TVR (-0.10; CI: -0.15 to -0.05), and MACE (-0.12; CI: -0.18 to -0.06). There was no significant difference between the groups in recurrent myocardial infarction (OR: 0.99; CI: 0.65 to 1.51) or stent thrombosis (OR: 0.78; CI: 0.40 to 1.52). Conclusions In this meta-analysis comparing DES with BMS use in PCI of SVG lesions, DES use was associated with improved mortality, MACE, TLR, and TVR. There was no evidence of increased risk of myocardial infarction or stent thrombosis. (J Am Coll Cardiol Intv 2010;3:1262-73) (C) 2010 by the American College of Cardiology Foundation