The short‐ and long‐term outcomes of percutaneous intervention with drug‐eluting stent vs bare‐metal stent in saphenous vein graft disease: An updated meta‐analysis of all randomized clinical trials

Abstract

The use of drug-eluting stents (DES) vs bare-metal stents (BMS) in saphenous vein graft (SVG) lesions remains controversial. We conducted a meta-analysis of all randomized clinical trials comparing the outcomes of DES with BMS in SVG percutaneous coronary interventions. A search of PubMed, Embase, the Cochrane Register of Controlled Trials, and Clinicaltrials.gov was performed for all randomized clinical trials. We evaluated the short- and long-term clinical outcomes of the following: all-cause mortality, major adverse cardiovascular events (MACE), definite/probable stent thrombosis, target lesion revascularization (TLR), and target-vessel revascularization (TVR). From a total of 1582 patients in 6 randomized clinical trials, 797 had DES and 785 had BMS. Patients with DES had lower short-term MACE, TLR, and TVR in comparison with BMS (odds ratio [OR]: 0.56, 95% confidence interval [CI]: 0.35-0.91, P = 0.02; OR: 0.43, 95% CI: 0.19-0.99, P = 0.05; and OR: 0.45, 95% CI: 0.22-0.95, P = 0.04, respectively). However, there were no different outcomes for all-cause mortality (P = 0.63) or stent thrombosis (P = 0.21). With long-term follow-up, there were no significant reductions of MACE (P = 0.20), TLR (P = 0.57), TVR (P = 0.07), all-cause mortality (P = 0.29), and stent thrombosis (P = 0.76). The use of DES in SVG lesions was associated with lower short-term MACE, TLR, and TVR in comparison with BMS. However, there were no significant differences with long-term follow-up.

Update on Cardiac Catheterization in Patients With Prior Coronary Artery Bypass Graft Surgery

“…During long-term follow-up, the 2 larger studies showed no difference between DES and BMS (54,56), and another showed worse outcomes with DES (59). In a meta-analysis of the 6 previously mentioned randomized trials by Kheiri et al (60), there were no significant differences between DES and BMS in the long-term incidence of MACE, target lesion revascularization, target vessel revascularization, stent thrombosis, and all-cause mortality. 1 and 2.…”

Saphenous vein graft disease, pathophysiology, prevention, and treatment. A review of the literature

“…Regarding the choice of the stent, recent studies suggest that drug‐eluting stents may offer an advantage over bare‐metal stents. Long‐term results are better with PCI than with medical treatment alone but are far from ideal and are indeed worse than outcomes of patients without vein graft failure 7,69 …”

Filter-based embolic protection device in saphenous vein graft percutaneous intervention: A case report

“…According to our case, the patient received drug-eluting stent (DES) for SVG PCI. Previous studies comparing DES and bare-metal stent (BMS) in the SVG intervention found that DES was superior over BMS in terms of reducing short-term MACE, total lesion revascularization (TLR), and TVR significantly [13 , 16] . Additionally, to improve the outcomes of revascularization, dual-antiplatelet therapy using aspirin and ticagrelor is indicated significantly increased graft patency after 1 year vs aspirin alone [17] .…”