Abstract
BackgroundSaphenous vein grafts develop an aggressive atherosclerotic process and the efficacy of drug eluting stents (DES) in treating saphenous vein graft (SVG) lesions has not been convincingly demonstrated. The aim of this study was to review and analyze the current literature for controlled studies comparing DES versus bare metal stents (BMS) for treatment of SVG stenoses.Methodology/Principal FindingsWe searched several scientific databases and conference proceedings up to March 15, 2010 for controlled studies comparing target vessel revascularization (TVR) between DES and BMS. Summary odds ratios (OR) for the primary endpoint TVR and secondary endpoints infarction, stent thrombosis and death were calculated using random-effect models. A total of 29 studies (3 randomized controlled trials RCT) involving 7549 (202 in RCT) patients were included. The need for target vessel revascularization in the DES group tended to be lower compared to BMS for the 3 RCT (OR 0.50 [0.24–1.00]; p = 0.051) and for observational studies (0.62 [0.49–0.79]; p<0.001). There was no significant difference in the risk for myocardial infarction in the RCT (OR 1.25 [0.22–6.99]; p = 0.250) but a lower risk for DES based on the observational studies 0.68 [0.49–0.95]; p = 0.023. The risk for stent thrombosis was found to be non-different in the RCT (OR 0.78 [0.03–21.73], p = 0.885) while it was in favor of DES in the observational studies (0.58 [0.38 – 0.84]; p<0.001). The mortality was not significantly different between DES and BMS in the RCT's (OR 2.22 [0.17 – 29.50]; p = 0.546) while the observation studies showed a decreased mortality in the DES group (0.69 [0.55–0.85]; p<0.001).ConclusionDES may decrease TVR rate in treatment of SVG stenoses. No differences in reinfarction rate, stent thrombosis or mortality was found between the DES and BMS groups in the RCT's while the observational data showed lower risk for myocardial infarction, stent thrombosis and death in the DES group. This may be a result of patient selection bias in the observational studies or represent a true finding that was not the detected in the RCT analysis due to limited statistical power.
Highlights
Coronary artery bypass graft (CABG) is among the most frequently performed surgical procedures in the U.S and Europe and a mainstay of therapy for coronary artery disease (CAD)
No differences in reinfarction rate, stent thrombosis or mortality was found between the drug eluting stents (DES) and bare metal stents (BMS) groups in the RCT’s while the observational data showed lower risk for myocardial infarction, stent thrombosis and death in the DES group
This may be a result of patient selection bias in the observational studies or represent a true finding that was not the detected in the RCT analysis due to limited statistical power
Summary
Coronary artery bypass graft (CABG) is among the most frequently performed surgical procedures in the U.S and Europe and a mainstay of therapy for coronary artery disease (CAD). SVG interventions currently account for about 5–10% of total percutaneous coronary interventions (PCI) annually in the United States.[1,2] This number is likely to increase in the near future since there is emerging evidence that even lower degree stenoses (30–60%) may profit from stent implantations;[3] very much in contrast to stenoses in native vessels where increasing data suggest that only hemodynamically significant higher degree stenoses should be treated.[4] The natural and post-interventional biological behaviour of saphenous vein grafts clearly differs from native vessels, they are at higher risk for restenosis.[5] While BMS are currently the gold standard for SVG stenosis, the off-label use of DES has shown promising results in several observational studies while there is a dearth of adequately powered randomized trials. The aim of this study was to review and analyze the current literature for controlled studies comparing DES versus bare metal stents (BMS) for treatment of SVG stenoses
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