Safety and efficacy of drug-eluting stents versus bare-metal stents in saphenous vein grafts lesions: a meta-analysis.
Controversy exists about the safety and efficacy of drug-eluting stents (DES) in saphenous vein bypass grafts (SVGs). The aim of this study was to perform a meta-analysis of all published studies comparing DES and bare-metal stents (BMS) in patients with SVGs disease.



We included 22 studies comparing DES versus BMS in 5,543 patients with SVGs disease. The primary efficacy endpoint was target vessel revascularisation (TVR). The primary safety endpoint was mortality. Other outcomes of interest were cardiac mortality, myocardial infarction, target lesion revascularisation (TLR), stent thrombosis and a combined of major adverse cardiac events (MACE). DES significantly reduced the risk of TVR, OR=0.56 (95% CI, 0.41-0.76, p=0.0003) and TLR, OR=0.58 (95% CI, 0.41-0.81; p=0.001). Total mortality and cardiac mortality were significantly lower in DES versus BMS, OR=0.69 (95% CI, 0.49-0.98, p=0.04) and OR=0.71 (95% CI, 0.51-0.99; p=0.04), respectively. The overall risk of stent thrombosis, and myocardial infarction were not significantly different for patients receiving DES vs. BMS. Total MACE were significantly lower in patients receiving DES, OR=0.55 (95% CI, 0.42-0.71; p<0.00001).



This meta-analysis suggests that the use of DES in patients with SVG lesions is associated with a reduction of the need of reintervention and mortality compared with BMS.
Sanchez-Recalde
Angel
A
Interventional Cardiology Unit, Hospital Universitario La Paz, Madrid, Spain. recalde@secardiologia.es
Jiménez Valero
Santiago
S
Moreno
Raul
R
Barreales
Laura
L
Lozano
Iñigo
I
Galeote
Guillermo
G
Martín Reyes
Roberto
R
Calvo
Luis
L
Lopez-Sendon
Jose L
JL
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D054855:Drug-Eluting Stents; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008670:Metals; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D016017:Odds Ratio; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D012501:Saphenous Vein / Q000637:transplantation*; D015607:Stents; D013927:Thrombosis / Q000209:etiology; D016896:Treatment Outcome
D008670:Metals