Drug eluting stent versus bare metal stent in saphenous vein graft lesions: a comprehensive meta-analysis of 14,000 patients

Abstract

Introduction: Drug eluting stents (DES) have been shown to significantly reduce the rate of target lesion revascularization in native coronary arteries compared to bare metal stents (BMS). However, there have been conflicting results use of DES in saphenous vein graft (SVG) lesions. Therefore, we aimed to investigate the risk of death, re-infarction (re-MI), target lesion revascularization (TLR) and/or target vessel revascularization (TVR), stent thrombosis (ST) and MACE compared to BMS in SVG lesions. Methods: We searched PubMed and Cochran Library from January 2003 to December 2014. We extracted outcomes such as all-cause mortality, re-MI, TVR/TLR, ST and MACE. Because majority of trials were non-RCT, we pooled all trials data to analyze end-points. Additionally, independent analyses were separately conducted in randomized studies. Results: We included 4 RCTs and 35 non-RCTs (a total 13958 patients, 6436 patients in DES arm and 7522 patients in BMS arm). In the pooled population, use of DES were significantly associated with lower risk of death (11.1% vs 14.1%, RR=1.282 (1.103–1.489) and p=0.001), re-MI (10.2% vs 11.7%, RR=1.135 (0.999–1.290) and p=0.051), TVR/TLR (15.1% vs 18.8%, RR=1.165 (1.023– 1.326), p=0.021 and 8.7% vs 13.4%, RR=1.535 (1.213–1.944), p<0.001, respectively), and MACE (23.8% vs 30.3%, RR=1.272 (1.153–1.404) and p<0.001). The risk of ST was similar between DES and BMS (1.3% vs 1.9%, RR=1.254 (0.819–1.919) and p=0.298). Specifically, in RCTs, the risk of death (RR=0.660 (0.179–2.436) and p=0.533), re-MI (RR: 1.149 (0.520–2.534) and p=0.732), ST (RR=1.346 (0.825–2.194) and p=0.234) and MACE (RR: 1.346 (0.825–2.194) and p=0.234) were similar, however, use of DES were significantly associated with lower TVR/TLR (Risk ratio for TVR is 1.452 (1.048–2.012) and p=0.025 and for TLR is 1.939 (1.053–3.572) and p=0.034). Conclusion: Our meta-analysis results showed that use of DES might improve cardiovascular outcomes compared to BMS in SVG lesions.