Clinical outcomes of percutaneous interventions in saphenous vein grafts using drug-eluting stents compared to bare-metal stents: A comprehensive meta-analysisof all randomized clinical trials

Mahboob Alam, Salman J. Bandeali, Salim S. Virani, Hani M. Jneid, Saima A. Shahzad, Kodangudi B. Ramanathan, Biswajit Kar, Neal S. Kleiman, Nasser Lakkis

Research output: Contribution to journalArticle

20 Scopus citations

Abstract

Background: Clinical outcomes of percutaneous coronary intervention (PCI) in patients with saphenous vein grafts (SVGs) remain poor despite the use of drug-eluting stents (DES). There is a disparity in clinical outcomes in SVG PCI based on various registries, and randomized clinical data remain scant. We conducted a meta-analysis of all existing randomized controlled trials (RCTS) comparing bare-metal stents (BMS) and DES in SVGPCIs. Hypothesis: PCI in patients with SVG disease using DES may reduce need for repeat revascularization without an excess mortality when compared to BMS. Methods: An aggregate data meta-analysis of clinical outcomes in RCTs comparing PCI with DES vs BMS for SVGs reporting at least 12 months of follow-up was performed. A literature search between Janurary 1, 2003 and September 30, 2011 identified 4 RCTs (812 patients; DES = 416, BMS = 396). Summary odds ratio (OR) and 95% confidence interval (CI) were calculated using the random-effects model. The primary endpoint was all-cause mortality. Secondary outcomes included nonfatal myocardial infarction (MI), repeat revascularization, and major adverse cardiac events (MACE). These outcomes were assessed in a cumulative fashion at 30 days, 18 months, and 36 months. Results: There were no intergroup differences in baseline clinical and sociodemographic characteristics. At a median follow-up of 25 months, patients in the DES and BMS group had similar rates of death (OR: 1.63, 95% CI: 0.45-5.92), MI (OR; 0.83, 95% CI: 0.27-2.60), and MACE (OR: 0.58, 95% CI: 0.25-1.32). Patients treated with DES had lower rates of repeat revascularization (OR: 0.40, 95% CI: 0.22-0.75). Conclusions: In this comprehensive meta-analysis of all RCTs comparing clinical outcomes of PCI using DES vs BMS in patients with SVG disease, use of DES was associated with a reduction in rate of repeat revascularization and no difference in rates of all-cause death and MI.

Original languageEnglish (US)
Pages (from-to)291-296
Number of pages6
JournalClinical Cardiology
Volume35
Issue number5
DOIs
StatePublished - May 2012

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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