Comparison of Angiographic Outcomes after Drug-eluting Stents and Bare-metal Stents in Patients with Cardiac Allograft Vasculopathy: A Metanalysis

Abstract

Background Coronary Allograft Vasculopathy (CAV) is a major determinant of long term survival after cardiac transplantation and remains one of the leading causes of death after the first year of orthotopic heart transplantation (OHT). Percutaneous revascularization is an option for amenable lesions with either drug-eluting stents (DES) or bare-metal stents (BMS). Choice of stent is dependent on patient and angiographic characteristics. Previous studies comparing the two stent subtypes have shown inconsistent results and thus we decided to do a meta-analysis to evaluate the net clinical effect. Methods PubMed, Medline & EMBASE were queried for all English articles from 1993 to 2017. Inclusion criteria were patients with CAV undergoing percutaneous coronary intervention with either DES or BMS with follow up angiography at 1 year. Primary outcome was In-stent restenosis (ISR): defined as more than 50% stenosis of the stent diameter angiographically. Secondary outcome was mortality. Outcomes were analyzed in two groups: Patient-based analysis and Lesion-based analysis. Data were pooled with absolute event rate and metanalysis of the outcomes was performed using a weighted random effects model in RevMAN 5.0. Results Seven studies including a total of 526 angiographic lesions (BMS 267; 50.7%) and 268 patients were analyzed. On lesion-based analysis, mean incidence of ISR in the BMS group vs the DES group was 31% vs 10.2% (RR 0.36; 95% CI 0.19–0.69; p=0.002). No difference in mortality was observed between the two groups (RR 0.86; 95% CI 0.16–0.46; p=0.86). Forest-plots for the outcomes are shown below. Conclusion Our analysis suggests that when compared with BMS implantation, DES have a lower rate of in-stent restenosis but offer no reduction in mortality at 1 year.