Drug-eluting stents versus bare metal stents for saphenous vein graft revascularisation: a meta-analysis of randomised trials.

Abstract

Percutaneous coronary intervention (PCI) of saphenous vein grafts (SVG) is associated with worse outcomes as compared with native coronary arteries. Previous studies comparing drug-eluting stents (DES) with bare metal stents (BMS) for PCI of SVG have yielded inconsistent results. Therefore, we aimed to perform a comprehensive meta-analysis of randomised trials comparing DES versus BMS for SVG PCI. Randomised trials that reported clinical outcomes and compared DES versus BMS for PCI of SVG were included. Summary estimates risk ratios (RRs) were constructed using a DerSimonian and Laird model. The primary outcome was major adverse cardiac events (MACE). Five trials with 1,535 patients were analysed. At a mean of 24.5 months, there was no difference in the risk of MACE (22.7% in the DES group versus 33.5% in the BMS group; RR 0.75, 95% CI: 0.49-1.16), all-cause mortality (9.5% versus 5.6%; RR 1.30, 95% CI: 0.77-2.18), cardiac mortality (5.5% versus 3.6%; RR 1.29, 95% CI: 0.53-3.15), myocardial infarction (7.1% versus 11.7%; RR 0.70, 95% CI: 0.40-1.22), stent thrombosis (2.5% versus 6.1%; RR 0.73, 95% CI: 0.26-2.03), and target vessel revascularisation (11.7% versus 24.4%; RR 0.66, 95% CI: 0.41-1.04) between DES and BMS. Data from randomised trials indicate that DES are safe for PCI for SVG disease. The risk of MACE, mortality, myocardial infarction, stent thrombosis or target vessel revascularisation was not statistically significantly different between the devices. Novel therapies are needed in the management of this subset of patients.