Drug eluting versus bare metal stents for percutaneous coronary intervention of saphenous vein graft lesions

An updated meta-analysis of randomized controlled trials

Francis J. Ha, Jason Nogic, Rocco A. Montone, James D. Cameron, Nitesh Nerlekar, Adam J. Brown

Research output: Contribution to journalArticleResearchpeer-review

1 Citation (Scopus)

Abstract

Background/purpose: Percutaneous coronary intervention (PCI) is the preferred strategy for treatment of saphenous vein graft (SVG) disease. However, there remains ongoing debate on whether drug-eluting stents (DES) or bare-metal stents (BMS) should be used during SVG-PCI. Methods/materials: We performed a meta-analysis of randomized controlled trials (RCTs) comparing DES and BMS for SVG-PCI. The primary end point was major adverse cardiac events (MACE), defined as composite of all-cause death, myocardial infarction (MI) or repeat revascularization. Secondary end points included individual MACE components, cardiac death and stent thrombosis (ST). Results: Six RCTs including 1582 patients (50% receiving DES) met inclusion criteria. MACE occurred in 31% (244/797) patients receiving DES and 36% (281/785) patients receiving BMS (median follow-up, 12–35 months). There was no significant difference in MACE between DES and BMS (Odds Ratio (OR) 0.62, 95%CI 0.36–1.09, p = 0.10, I2 = 77%). However, for individual components of MACE, DES was associated with a significant reduction in repeat revascularization (OR 0.53, 95%CI 0.29–0.97, p = 0.04, I2 = 73%). There was no difference in all-cause death (OR 1.30, 95%CI 0.77–2.20, p = 0.33, I2 = 40%), MI (OR 0.68, 95%CI 0.38–1.25, p = 0.22, I2 = 56%), cardiac death (OR 1.08, 95%CI 0.45–2.64, p = 0.86, I2 = 42%) or ST (OR 0.89, 95%CI 0.37–2.17, p = 0.80, I2 = 35%) between stents. Conclusions: Although there was no significant difference in MACE, DES is associated with a reduction in repeat revascularization compared with BMS in pooled randomized trials for SVG-PCI. The high occurrence of MACE in both stent platforms highlights the need for novel therapeutic approaches to improve clinical outcomes following SVG intervention. We performed a meta-analysis of randomized controlled trials comparing DES and BMS for SVG-PCI. There was no significant difference in MACE between DES and BMS. However, for individual components of MACE, DES was associated with a significant reduction in repeat revascularization. The high occurrence of MACE in both stent platforms highlights the need for novel therapeutic approaches to improve clinical outcomes following SVG intervention.

Original languageEnglish
Pages (from-to)837-844
Number of pages8
JournalCardiovascular Revascularization Medicine
Volume19
Issue number7
DOIs
Publication statusPublished - Oct 2018

Keywords

  • Bare metal stent
  • Drug eluting stent
  • Meta-analysis
  • Percutaneous coronary intervention
  • Randomized controlled trials
  • Saphenous vein graft

Cite this

@article{cc06840cdc8645d58c782e3bb26e47c0,
title = "Drug eluting versus bare metal stents for percutaneous coronary intervention of saphenous vein graft lesions: An updated meta-analysis of randomized controlled trials",
abstract = "Background/purpose: Percutaneous coronary intervention (PCI) is the preferred strategy for treatment of saphenous vein graft (SVG) disease. However, there remains ongoing debate on whether drug-eluting stents (DES) or bare-metal stents (BMS) should be used during SVG-PCI. Methods/materials: We performed a meta-analysis of randomized controlled trials (RCTs) comparing DES and BMS for SVG-PCI. The primary end point was major adverse cardiac events (MACE), defined as composite of all-cause death, myocardial infarction (MI) or repeat revascularization. Secondary end points included individual MACE components, cardiac death and stent thrombosis (ST). Results: Six RCTs including 1582 patients (50{\%} receiving DES) met inclusion criteria. MACE occurred in 31{\%} (244/797) patients receiving DES and 36{\%} (281/785) patients receiving BMS (median follow-up, 12–35 months). There was no significant difference in MACE between DES and BMS (Odds Ratio (OR) 0.62, 95{\%}CI 0.36–1.09, p = 0.10, I2 = 77{\%}). However, for individual components of MACE, DES was associated with a significant reduction in repeat revascularization (OR 0.53, 95{\%}CI 0.29–0.97, p = 0.04, I2 = 73{\%}). There was no difference in all-cause death (OR 1.30, 95{\%}CI 0.77–2.20, p = 0.33, I2 = 40{\%}), MI (OR 0.68, 95{\%}CI 0.38–1.25, p = 0.22, I2 = 56{\%}), cardiac death (OR 1.08, 95{\%}CI 0.45–2.64, p = 0.86, I2 = 42{\%}) or ST (OR 0.89, 95{\%}CI 0.37–2.17, p = 0.80, I2 = 35{\%}) between stents. Conclusions: Although there was no significant difference in MACE, DES is associated with a reduction in repeat revascularization compared with BMS in pooled randomized trials for SVG-PCI. The high occurrence of MACE in both stent platforms highlights the need for novel therapeutic approaches to improve clinical outcomes following SVG intervention. We performed a meta-analysis of randomized controlled trials comparing DES and BMS for SVG-PCI. There was no significant difference in MACE between DES and BMS. However, for individual components of MACE, DES was associated with a significant reduction in repeat revascularization. The high occurrence of MACE in both stent platforms highlights the need for novel therapeutic approaches to improve clinical outcomes following SVG intervention.",
keywords = "Bare metal stent, Drug eluting stent, Meta-analysis, Percutaneous coronary intervention, Randomized controlled trials, Saphenous vein graft",
author = "Ha, {Francis J.} and Jason Nogic and Montone, {Rocco A.} and Cameron, {James D.} and Nitesh Nerlekar and Brown, {Adam J.}",
year = "2018",
month = "10",
doi = "10.1016/j.carrev.2018.03.025",
language = "English",
volume = "19",
pages = "837--844",
journal = "Cardiovascular Revascularization Medicine",
issn = "1553-8389",
publisher = "Elsevier",
number = "7",

}

TY - JOUR

T1 - Drug eluting versus bare metal stents for percutaneous coronary intervention of saphenous vein graft lesions

T2 - An updated meta-analysis of randomized controlled trials

AU - Ha, Francis J.

AU - Nogic, Jason

AU - Montone, Rocco A.

AU - Cameron, James D.

AU - Nerlekar, Nitesh

AU - Brown, Adam J.

PY - 2018/10

Y1 - 2018/10

N2 - Background/purpose: Percutaneous coronary intervention (PCI) is the preferred strategy for treatment of saphenous vein graft (SVG) disease. However, there remains ongoing debate on whether drug-eluting stents (DES) or bare-metal stents (BMS) should be used during SVG-PCI. Methods/materials: We performed a meta-analysis of randomized controlled trials (RCTs) comparing DES and BMS for SVG-PCI. The primary end point was major adverse cardiac events (MACE), defined as composite of all-cause death, myocardial infarction (MI) or repeat revascularization. Secondary end points included individual MACE components, cardiac death and stent thrombosis (ST). Results: Six RCTs including 1582 patients (50% receiving DES) met inclusion criteria. MACE occurred in 31% (244/797) patients receiving DES and 36% (281/785) patients receiving BMS (median follow-up, 12–35 months). There was no significant difference in MACE between DES and BMS (Odds Ratio (OR) 0.62, 95%CI 0.36–1.09, p = 0.10, I2 = 77%). However, for individual components of MACE, DES was associated with a significant reduction in repeat revascularization (OR 0.53, 95%CI 0.29–0.97, p = 0.04, I2 = 73%). There was no difference in all-cause death (OR 1.30, 95%CI 0.77–2.20, p = 0.33, I2 = 40%), MI (OR 0.68, 95%CI 0.38–1.25, p = 0.22, I2 = 56%), cardiac death (OR 1.08, 95%CI 0.45–2.64, p = 0.86, I2 = 42%) or ST (OR 0.89, 95%CI 0.37–2.17, p = 0.80, I2 = 35%) between stents. Conclusions: Although there was no significant difference in MACE, DES is associated with a reduction in repeat revascularization compared with BMS in pooled randomized trials for SVG-PCI. The high occurrence of MACE in both stent platforms highlights the need for novel therapeutic approaches to improve clinical outcomes following SVG intervention. We performed a meta-analysis of randomized controlled trials comparing DES and BMS for SVG-PCI. There was no significant difference in MACE between DES and BMS. However, for individual components of MACE, DES was associated with a significant reduction in repeat revascularization. The high occurrence of MACE in both stent platforms highlights the need for novel therapeutic approaches to improve clinical outcomes following SVG intervention.

AB - Background/purpose: Percutaneous coronary intervention (PCI) is the preferred strategy for treatment of saphenous vein graft (SVG) disease. However, there remains ongoing debate on whether drug-eluting stents (DES) or bare-metal stents (BMS) should be used during SVG-PCI. Methods/materials: We performed a meta-analysis of randomized controlled trials (RCTs) comparing DES and BMS for SVG-PCI. The primary end point was major adverse cardiac events (MACE), defined as composite of all-cause death, myocardial infarction (MI) or repeat revascularization. Secondary end points included individual MACE components, cardiac death and stent thrombosis (ST). Results: Six RCTs including 1582 patients (50% receiving DES) met inclusion criteria. MACE occurred in 31% (244/797) patients receiving DES and 36% (281/785) patients receiving BMS (median follow-up, 12–35 months). There was no significant difference in MACE between DES and BMS (Odds Ratio (OR) 0.62, 95%CI 0.36–1.09, p = 0.10, I2 = 77%). However, for individual components of MACE, DES was associated with a significant reduction in repeat revascularization (OR 0.53, 95%CI 0.29–0.97, p = 0.04, I2 = 73%). There was no difference in all-cause death (OR 1.30, 95%CI 0.77–2.20, p = 0.33, I2 = 40%), MI (OR 0.68, 95%CI 0.38–1.25, p = 0.22, I2 = 56%), cardiac death (OR 1.08, 95%CI 0.45–2.64, p = 0.86, I2 = 42%) or ST (OR 0.89, 95%CI 0.37–2.17, p = 0.80, I2 = 35%) between stents. Conclusions: Although there was no significant difference in MACE, DES is associated with a reduction in repeat revascularization compared with BMS in pooled randomized trials for SVG-PCI. The high occurrence of MACE in both stent platforms highlights the need for novel therapeutic approaches to improve clinical outcomes following SVG intervention. We performed a meta-analysis of randomized controlled trials comparing DES and BMS for SVG-PCI. There was no significant difference in MACE between DES and BMS. However, for individual components of MACE, DES was associated with a significant reduction in repeat revascularization. The high occurrence of MACE in both stent platforms highlights the need for novel therapeutic approaches to improve clinical outcomes following SVG intervention.

KW - Bare metal stent

KW - Drug eluting stent

KW - Meta-analysis

KW - Percutaneous coronary intervention

KW - Randomized controlled trials

KW - Saphenous vein graft

UR - http://www.scopus.com/inward/record.url?scp=85045729742&partnerID=8YFLogxK

U2 - 10.1016/j.carrev.2018.03.025

DO - 10.1016/j.carrev.2018.03.025

M3 - Article

VL - 19

SP - 837

EP - 844

JO - Cardiovascular Revascularization Medicine

JF - Cardiovascular Revascularization Medicine

SN - 1553-8389

IS - 7

ER -