title: Drug-eluting stents vs. bare metal stents in saphenous vein graft disease. Insights from a meta-analysis of 7,090 patients.
abstract: BACKGROUND
  Evidence supporting the use of drug-eluting stents (DES) in saphenous vein graft (SVG) disease is uncertain. Previous studies have suggested that DES might reduce the re-intervention rate in SVG disease, with conflicting data on mortality. Thus, a meta-analysis was performed to compare outcomes of DES vs. bare metal stent (BMS) in SVG disease.
  
  
  RESULTS
  Medline and Web databases were searched for studies comparing DES and BMS for SVG disease, reporting rates of overall mortality, target vessel revascularization (TVR) and myocardial infarction (MI) with a follow-up of ≥6 months. The meta-analysis included 23 studies (7,090 patients). Compared with BMS, DES-treated patients had lower rates of TVR (odds ratio (OR), 0.53; confidence interval (CI), 0.39-0.72; P<0.0001) and overall mortality (OR, 0.63; CI, 0.40-0.99; P=0.05), but similar rates of MI (OR, 0.92; CI, 0.64-1.33; P=0.7). Subgroup analysis highlighted differences between non-randomized studies, in which DES improved mortality rates, and randomized trials, in which benefit from DES was not evident. Meta-regression analysis showed that DES were more effective in the presence of older grafts and type 2 diabetes.
  
  
  CONCLUSIONS
  The present meta-analysis showed that, in SVG disease, DES significantly reduced TVR, but did not provide clear benefits on mortality and MI, with an opposite direction of results in mortality observed from randomized and observational data.
authors.affiliation: Cardiologia 2, Ospedale Maggiore della Carità, Novara, Italy. lupialessandro1@tin.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Lupi
authors.forename: Eliano Pio
authors.initials: EP
authors.lastname: Navarese
authors.forename: Maurizio
authors.initials: M
authors.lastname: Lazzero
authors.forename: Mara
authors.initials: M
authors.lastname: Sansa
authors.forename: Stefano
authors.initials: S
authors.lastname: De Servi
authors.forename: Antonio
authors.initials: A
authors.lastname: Serra
authors.forename: Angelo Sante
authors.initials: AS
authors.lastname: Bongo
authors.forename: Antonio
authors.initials: A
authors.lastname: Buffon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000295:instrumentation*; D015982:Bias; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000601:surgery; D023903:Coronary Restenosis / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000601:surgery; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D016017:Odds Ratio; D017239:Paclitaxel / Q000008:administration & dosage / Q000627:therapeutic use; D011183:Postoperative Complications / Q000401:mortality; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012044:Regression Analysis; D012501:Saphenous Vein / Q000187:drug effects / Q000473:pathology / Q000637:transplantation*; D020123:Sirolimus / Q000008:administration & dosage / Q000627:therapeutic use; D015607:Stents; D016896:Treatment Outcome
chemical_list: D017239:Paclitaxel; D020123:Sirolimus