title: A comparison of drug-eluting stents versus bare metal stents in saphenous vein graft PCI outcomes: a meta-analysis.
abstract: OBJECTIVE
  Studies demonstrate that percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is associated with reduced revascularization and major adverse cardiac events (MACE) rates compared to bare metal stents (BMS) in native coronary vessels. Optimal PCI treatment of saphenous vein graft (SVG) lesions remains unclear despite SVG procedures representing up to 10% of PCI cases. We therefore performed a meta-analysis to compare outcomes between BMS and DES in SVG PCI.
  
  
  RESULTS
  A search (2004-2009) of MEDLINE and conference proceedings for all relevant studies comparing mortality and MACE outcomes in DES versus BMS in SVG PCI and meta-analysis of the data was performed. Twenty studies were identified from 2005 to 2009 enrolling a total of 5,296 patients. Meta-analysis revealed a decrease in mortality associated with DES use, odds ratio (OR) 0.68; 95% confidence interval (CI) 0.53-0.88; P = 0.004. Similarly, MACE (OR 0.64; 95% CI 0.51-0.82; P < 0.001), total lesion revascularization (OR 0.60; 95% CI 0.43-0.83; P = 0.002), and total vessel revascularization (OR 0.57; 95% CI 0.41-0.80; P = 0.001) were significantly decreased in the patients in which DES were used compared to BMS. This reduction in mortality and MACE events associated with DES use appears to be limited to registry studies and not randomized controlled studies.
  
  
  CONCLUSIONS
  Our meta-analysis suggests DES use to be safe in SVG PCI and associated with reduced mortality and MACE rates with reductions in revascularization also observed.
authors.affiliation: Manchester Heart Centre, Manchester Royal Infirmary, Biomedical Research Centre, Oxford Road, Manchester, UK. mamasmamas1@yahoo.co.uk
authors.forename: Mamas A
authors.initials: MA
authors.lastname: Mamas
authors.forename: James
authors.initials: J
authors.lastname: Foley
authors.forename: Satheesh
authors.initials: S
authors.lastname: Nair
authors.forename: Andrew
authors.initials: A
authors.lastname: Wiper
authors.forename: Bernard
authors.initials: B
authors.lastname: Clarke
authors.forename: Magdi
authors.initials: M
authors.lastname: El-Omar
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Fraser
authors.forename: Rajdeep
authors.initials: R
authors.lastname: Khattar
authors.forename: Ludwig
authors.initials: L
authors.lastname: Neyses
authors.forename: Farzin
authors.initials: F
authors.lastname: Fath-Ordoubadi
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D001026:Coronary Artery Bypass; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D006801:Humans; D012501:Saphenous Vein / Q000637:transplantation*; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome