title: Drug eluting versus bare metal stents in cardiac allograft vasculopathy: a systematic review of literature.
abstract: BACKGROUND
  Cardiac allograft vasculopathy (CAV) is a distinct pathological condition characterized by diffuse and progressive arteriopathy and it is an important determinant of long-term graft survival. Definitive CAV treatment is retransplantation but palliation with stenting might temporarily alleviate it. The benefit of drug eluting stents (DES) over bare metal stents (BMS) in the treatment of such lesions is debatable. We therefore sought to do a literature search to review the available evidence comparing DES to BMS.
  
  
  METHODS
  We conducted Pub Med, EMBASE, Cochrane database review, Web of Science search of studies comparing DES with BMS in CAV. Available studies were retrospective in nature with either direct comparison groups (n = 5) or historical controls (n = 1). The main outcomes analyzed were in stent restenosis (ISR) during follow-up and clinical outcomes.
  
  
  RESULTS
  A total of 312 patients from six studies were included in the review (1995-2007). Most commonly used DES were sirolimus eluting stent. DES appeared to reduce the long-term risk of ISR compared with BMS. Three of the five studies showed a statistically significant reduction in ISR at 12 months while the one study assessing ISR at 6 months showed no significant difference. Clinical endpoints such as death and major adverse cardiac events were not statistically different.
  
  
  CONCLUSIONS
  DES appear to reduce the incidence of ISR in CAV as compared with BMS. Prospective randomized clinical trials are needed to determine the clinical benefit of DES beyond a reduction in ISR.
authors.affiliation: Department of Internal Medicine, Cardiovascular Section, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA. dasaritarun@gmail.com
authors.forename: Tarun W
authors.initials: TW
authors.lastname: Dasari
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Hennebry
authors.forename: Elias B
authors.initials: EB
authors.lastname: Hanna
authors.forename: Jorge F
authors.initials: JF
authors.lastname: Saucedo
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D003324:Coronary Artery Disease / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D023903:Coronary Restenosis / Q000209:etiology / Q000401:mortality; D054855:Drug-Eluting Stents; D019317:Evidence-Based Medicine; D005260:Female; D006085:Graft Survival; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D010166:Palliative Care; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D008670:Metals