Comparison of Drug-Eluting Stents With Bare-Metal Stents for PCI of Saphenous Vein Graft Lesions: Systematic Review and Meta-Analysis.
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BACKGROUND: The superiority of drug-eluting stent (DES) implantation over bare-metal stent (BMS) implantation in saphenous vein graft (SVG) lesions is controversial, with significant heterogeneity demonstrated in the literature. METHODS: A study search was conducted from January 2003 to October 2015, and identified four randomized controlled trials (RCTs) and 35 observational studies comparing DES vs BMS in SVG interventions. Clinical endpoint data were abstracted and analyzed by combining the odds ratios (ORs) of individual studies into a pooled OR using a random-effects model. RESULTS: The meta-analysis included 39,213 patients in the DES group and 26,461 patients in the BMS group. Patients who underwent percutaneous coronary intervention with DES had lower major adverse cardiovascular event (MACE) rate (OR, 0.63; 95% confidence interval [CI], 0.54-0.74; P<.001), lower all-cause mortality rate (OR, 0.76; 95% CI, 0.69-0.84; P<.001), lower target-vessel revascularization (TVR) rate (OR, 0.70; 95% CI, 0.57-0.86; P<.001), and lower target-lesion revascularization (TLR) rate (OR, 0.64; 95% CI, 0.50-0.84; P<.01), with no difference in stent thrombosis (OR, 0.90; 95% CI, 0.61-1.32; P=.58). There was no significant reduction in myocardial infarction (MI) in the DES group compared with the BMS group (OR, 0.87; 95% CI, 0.73-1.04; P=.13). Benefits were sustained at long-term follow-up of 36 months without an increased risk of early and/or late stent thrombosis. The observed benefit for MACE was only seen in observational studies (OR, 0.63; 95% CI, 0.53-0.75; P<.001) with no benefit in RCTs (OR, 0.53; 95% CI, 0.20-1.40; P=.20). CONCLUSIONS: The results suggest that patients with DES in comparison with BMS implantation for PCI to SVG lesions had lower MACE, all-cause mortality, and TVR rates, without a significant reduction in MI and TLR.
