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Lin L, Lu W, Wang X, Pan L, Wang X, Zheng X, Li R, Shan Y, Peng M, Qiu C. Short-term outcomes of drug-coated balloon versus drug-eluting stent for de novo saphenous vein graft lesions in coronary heart disease. Front Cardiovasc Med 2023; 10:982880. [PMID: 36950290 PMCID: PMC10025469 DOI: 10.3389/fcvm.2023.982880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 02/17/2023] [Indexed: 03/08/2023] Open
Abstract
Background As a device for percutaneous coronary intervention, drug-coated balloon (DCB) is widely used to treat in-stent restenosis. However, data regarding the use of DCB in treating de novo saphenous vein graft (SVG) lesions are limited. This study aimed to explore the outcomes of using the DCB in the treatment of de novo SVG lesions of coronary heart disease (CHD). Methods This retrospective and observational study analyzed CHD patients with de novo SVG lesions treated with DCB or the new-generation drug-eluting stent (DES) between January 2018 and December 2020. Restenosis was the primary endpoint, whereas target lesion revascularization (TLR), major adverse cardiac events, restenosis, cardiac death, target vessel revascularization, and myocardial infarction were the secondary outcomes. Results We enrolled 31 and 23 patients treated with DCB and DES, respectively. The baseline clinical data, lesion characteristics, and procedural characteristics were similar between the two groups. Twenty-eight (90.3%) patients in the DCB group and 21 (91.3%) in the DES group completed follow-up angiography after 1 year. The quantitative coronary angiography measurements at angiographic follow-up showing late lumen loss were -0.07 ± 0.95 mm for the DCB group and 0.86 ± 0.71 mm for the DES group (P = 0.039), and the rates of restenosis were 13.3% and 21.7% for the DCB and DES groups, respectively (P = 0.470). No significant differences were observed in the rates of MACE (16.7% vs. 26.1%, P = 0.402) and TLR (13.3% vs. 4.3%, P = 0.374) during clinical follow-up. Conclusion Our findings suggest that when pre-dilatation was successful, DCB might be safe and effective in treating de novo SVG lesions.
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Elgendy IY, Mahmoud AN, Brilakis ES, Bavry AA. Drug-eluting stents versus bare metal stents for saphenous vein graft revascularisation: a meta-analysis of randomised trials. EUROINTERVENTION 2018; 14:215-223. [DOI: 10.4244/eij-d-17-00839] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Aggarwal V, Stanislawski MA, Maddox TM, Nallamothu BK, Grunwald G, Adams JC, Ho PM, Rao SV, Casserly IP, Rumsfeld JS, Brilakis ES, Tsai TT. Safety and Effectiveness of Drug-Eluting Versus Bare-Metal Stents in Saphenous Vein Bypass Graft Percutaneous Coronary Interventions. J Am Coll Cardiol 2014; 64:1825-36. [DOI: 10.1016/j.jacc.2014.06.1207] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 05/21/2014] [Accepted: 06/30/2014] [Indexed: 12/22/2022]
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Hougaard M, Thayssen P, Kaltoft A, Tilsted HH, Maeng M, Flensted Lassen J, Thuesen L, Okkels Jensen L. Long-term outcome following percutaneous coronary intervention with drug-eluting stents compared with bare-metal stents in saphenous vein graft lesions: From Western Denmark heart registry. Catheter Cardiovasc Interv 2013; 83:1035-42. [DOI: 10.1002/ccd.25279] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 10/02/2013] [Accepted: 10/23/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Mikkel Hougaard
- Department of Cardiology; Odense University Hospital; Odense Denmark
| | - Per Thayssen
- Department of Cardiology; Odense University Hospital; Odense Denmark
| | - Anne Kaltoft
- Department of Cardiology; Aarhus University Hospital; Skejby Aarhus Denmark
| | | | - Michael Maeng
- Department of Cardiology; Aarhus University Hospital; Skejby Aarhus Denmark
| | | | - Leif Thuesen
- Department of Cardiology; Aarhus University Hospital; Skejby Aarhus Denmark
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Farhatnia Y, Tan A, Motiwala A, Cousins BG, Seifalian AM. Evolution of covered stents in the contemporary era: clinical application, materials and manufacturing strategies using nanotechnology. Biotechnol Adv 2013; 31:524-42. [DOI: 10.1016/j.biotechadv.2012.12.010] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 12/20/2012] [Accepted: 12/30/2012] [Indexed: 12/24/2022]
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Hoyt JR, Gurm HS. Drug-Eluting Stents Versus Bare Metal Stents in Saphenous Vein Graft Intervention. Interv Cardiol Clin 2013; 2:283-305. [PMID: 28582136 DOI: 10.1016/j.iccl.2012.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Percutaneous coronary intervention (PCI) of saphenous vein graft (SVG) is associated with higher adverse event rates, lower procedural success, and inferior longterm patency rates compared with native vessel PCI. The ability to comply with dual antiplatelet therapy, and whether the patient will need an interruption in dual antiplatelet therapy, should be considered when deciding whether to implant a drug-eluting stent (DES) or bare metal stent (BMS) in an SVG. DES should be used for SVG PCI because they seem to reduce target vessel revascularization. This article reviews the evolution and contemporary evidence regarding use of DES versus BMS in SVG PCI.
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Affiliation(s)
- John R Hoyt
- Division of Cardiovascular Disease, Department of Internal Medicine, University of Michigan Cardiovascular Center, University of Michigan, 1500 East Medical Center Drive, 2381 CVC SPC 5853, Ann Arbor, MI 48109-5853, USA
| | - Hitinder S Gurm
- Division of Cardiovascular Disease, Department of Internal Medicine, University of Michigan Cardiovascular Center, University of Michigan, 1500 East Medical Center Drive, Room 2A394, Ann Arbor, MI 48109-5853, USA.
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Foster C, Zajarias A. Degenerated Saphenous Vein Graft Intervention: Should We Target the Native Vessel instead? Interv Cardiol Clin 2013; 2:323-337. [PMID: 28582139 DOI: 10.1016/j.iccl.2012.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Coronary interventions of degenerated saphenous vein grafts (SVGs) continue to present a management challenge. Although repeat coronary artery bypass grafting (CABG) remains a significant risk factor for operative mortality, percutaneous coronary intervention (PCI) is still associated with a high risk for periprocedural events. There is a lack of consensus on the optimal treatment strategy for patients with severe stenosis of SVGs. It is imperative to review the characteristics of native versus SVG disease, risk factors for complications after SVG intervention, procedural treatment strategies important to the decision on which therapeutic strategy to follow, and measures to mitigate the risks of periprocedural complications.
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Affiliation(s)
- Corey Foster
- Cardiovascular Division, Department of Internal Medicine, Washington University School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA
| | - Alan Zajarias
- Cardiovascular Division, Department of Internal Medicine, Washington University School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA.
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Pasceri V, Tarsia G, Niccoli G, Viceconte N, Porto I, Leone AM, Trani C, Speciale G, LIsanti P. Early beneficial effects of drug-eluting stents in vein grafts wane during long term follow-up. Catheter Cardiovasc Interv 2012; 80:1112-7. [DOI: 10.1002/ccd.23468] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 10/23/2011] [Accepted: 10/29/2011] [Indexed: 11/09/2022]
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Singh IM, Holmes DR. Myocardial Revascularization by Percutaneous Coronary Intervention: Past, Present, and the Future. Curr Probl Cardiol 2011; 36:375-401. [DOI: 10.1016/j.cpcardiol.2011.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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10
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Mehilli J, Pache J, Abdel-Wahab M, Schulz S, Byrne RA, Tiroch K, Hausleiter J, Seyfarth M, Ott I, Ibrahim T, Fusaro M, Laugwitz KL, Massberg S, Neumann FJ, Richardt G, Schömig A, Kastrati A. Drug-eluting versus bare-metal stents in saphenous vein graft lesions (ISAR-CABG): a randomised controlled superiority trial. Lancet 2011; 378:1071-8. [PMID: 21872918 DOI: 10.1016/s0140-6736(11)61255-5] [Citation(s) in RCA: 138] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Comparative assessment of clinical outcomes after use of drug-eluting stents versus bare-metal stents for treatment of aortocoronary saphenous vein graft lesions has not been undertaken in large randomised trials. We aimed to undertake a comparison in a randomised trial powered for clinical endpoints. METHODS In this randomised superiority trial, patients with de-novo saphenous vein graft lesions were assigned by computer-generated sequence (1:1:1:3) to receive either drug-eluting stents (one of three types: permanent-polymer paclitaxel-eluting stents, permanent-polymer sirolimus-eluting stents, or biodegradable-polymer sirolimus-eluting stents) or bare-metal stents. Randomisation took place immediately after crossing of the lesion with a guidewire, and was stratified for each participating centre. Investigators assessing data were masked to treatment allocation; patients were not masked to allocation. The primary endpoint was the combined incidence of death, myocardial infarction, and target lesion revascularisation at 1 year. Analysis was by intention to treat. This trial is registered at ClinicalTrials.gov, number NCT00611910. FINDINGS 610 patients were allocated to treatment groups (303 drug-eluting stent, 307 bare-metal stent). Drug-eluting stents reduced the incidence of the primary endpoint compared with bare-metal stents (44 [15%] vs 66 [22%] patients; hazard ratio [HR] 0.64, 95% CI 0.44-0.94; p=0.02). Target lesion revascularisation rate was reduced by drug-eluting stents (19 [7%] vs 37 [13%] patients; HR 0.49, 95% CI 0.28-0.86; p=0.01). No significant differences were seen between drug-eluting stents and bare-metal stents regarding all-cause mortality (15 [5%] vs 14 [5%] patients; HR 1.08, 95% CI 0.52-2.24; p=0.83), myocardial infarction (12 [4%] vs 18 [6%]; HR 0.66, 95% CI 0.32-1.37; p=0.27), or definite or probable stent thrombosis (2 [1%] in both groups; HR 1.00, 95% CI 0.14-7.10; p=0.99). INTERPRETATION In patients undergoing percutaneous coronary intervention for de-novo saphenous vein graft lesions, drug-eluting stents are the preferred treatment option because they reduce the risk of adverse events compared with bare-metal stents. FUNDING Deutsches Herzzentrum.
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Affiliation(s)
- Julinda Mehilli
- Deutsches Herzzentrum, Technische Universität, Munich, Germany.
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Nair S, Fath-Ordoubadi F, Clarke B, El-Omar M, Foley J, Fraser DG, Mahadevan VS, Neyses L, Khattar RS, Mamas MA. Late outcomes of drug eluting and bare metal stents in saphenous vein graft percutaneous coronary intervention. EUROINTERVENTION 2011; 6:985-91. [PMID: 21330247 DOI: 10.4244/eijv6i8a170] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS PCI with drug eluting stents (DES) has been shown to reduce restenosis and major adverse cardiac event (MACE) rates compared to bare metal stents (BMS) in native coronary vessels, although outcomes in saphenous vein graft (SVG) lesions are less clear. We retrospectively studied 388 consecutive patients admitted to our centre for SVG PCI to assess mortality and MACE outcomes (defined as composite endpoint of all-death, stroke, myocardial infarction, stent thrombosis and target lesion (TLR)/vessel (TVR) revascularisation) associated with BMS and DES use. METHODS AND RESULTS Two hundred and nineteen (219) patients had BMS and 169 had DES (total 388 patients). Mean follow up was 41.9±23.5 months. No significant differences were observed in mortality (14.2% vs. 11.8%) or MACE (37.6% vs. 35.8%) between the BMS and DES groups at four years follow-up or at other intervening time points studied. Similarly, no differences in TVR/TLR rates were observed over a similar time period (19.8% vs. 21.6%). CONCLUSIONS We have observed that DES and BMS use in SVG PCI have comparable mortality and MACE rates, and that in contrast to PCI in native coronary arteries, DES do not reduce revascularisation rates in our study cohort.
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Affiliation(s)
- Satheesh Nair
- Manchester Heart Centre, Manchester Royal Infirmary, Biomedical Research Centre, and Manchester Academic Health Science Center, University of Manchester, Manchester, United Kingdom
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Ziada KM, Abdel-Latif A, Wiisanen ME. Reply. JACC Cardiovasc Interv 2011. [DOI: 10.1016/j.jcin.2011.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Brilakis ES, Lichtenwalter C, Abdel-karim ARR, de Lemos JA, Obel O, Addo T, Roesle M, Haagen D, Rangan BV, Saeed B, Bissett JK, Sachdeva R, Voudris VV, Karyofillis P, Kar B, Rossen J, Fasseas P, Berger P, Banerjee S. Continued Benefit From Paclitaxel-Eluting Compared With Bare-Metal Stent Implantation in Saphenous Vein Graft Lesions During Long-Term Follow-Up of the SOS (Stenting of Saphenous Vein Grafts) Trial. JACC Cardiovasc Interv 2011; 4:176-82. [DOI: 10.1016/j.jcin.2010.10.003] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2010] [Revised: 09/24/2010] [Accepted: 10/05/2010] [Indexed: 10/18/2022]
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MAMAS MAMASA, FOLEY JAMES, NAIR SATHEESH, WIPER ANDREW, CLARKE BERNARD, EL-OMAR MAGDI, FRASER DOUGLASG, KHATTAR RAJDEEP, NEYSES LUDWIG, FATH-ORDOUBADI FARZIN. A Comparison of Drug-Eluting Stents versus Bare Metal Stents in Saphenous Vein Graft PCI Outcomes: A Meta-Analysis. J Interv Cardiol 2011; 24:172-80. [DOI: 10.1111/j.1540-8183.2010.00620.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Lupi A, Navarese EP, Lazzero M, Sansa M, Servi SD, Serra A, Bongo AS, Buffon A. Drug-Eluting Stents vs. Bare Metal Stents in Saphenous Vein Graft Disease - Insights From a Meta-Analysis of 7,090 Patients -. Circ J 2011; 75:280-9. [DOI: 10.1253/circj.cj-10-0186] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Eliano Pio Navarese
- Istituto di Cardiologia, Università Cattolica del Sacro Cuore
- Interventional Cardiology Unit, Hospital de la Santa Creu i Sant Pau
| | | | - Mara Sansa
- Cardiologia 2, Ospedale Maggiore della Carità
| | | | - Antonio Serra
- Interventional Cardiology Unit, Hospital de la Santa Creu i Sant Pau
| | | | - Antonio Buffon
- Istituto di Cardiologia, Università Cattolica del Sacro Cuore
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Al-Lamee R, Ielasi A, Latib A, Godino C, Ferraro M, Arioli F, Mussardo M, Piraino D, Figini F, Carlino M, Montorfano M, Chieffo A, Colombo A. Clinical and angiographic outcomes after percutaneous recanalization of chronic total saphenous vein graft occlusion using modern techniques. Am J Cardiol 2010; 106:1721-7. [PMID: 21126616 DOI: 10.1016/j.amjcard.2010.08.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 08/03/2010] [Accepted: 08/11/2010] [Indexed: 12/29/2022]
Abstract
Poor long-term outcomes after percutaneous coronary intervention (PCI) in chronic total occlusion (CTO) of saphenous vein grafts (SVGs) have been reported. However, limited data are available evaluating the use of modern techniques in this group. The aim of the present study was to assess the efficacy and long-term outcomes of PCI in SVG CTO with the routine use of embolic protection devices and drug-eluting stents. A retrospective cohort analysis was conducted of all consecutive patients undergoing PCI to SVG CTO from May 2002 to July 2009 at 2 centers. The indication for PCI was the presence of angina or silent ischemia with evidence of inducible ischemia after functional testing in the territory supplied by the SVG, despite optimal medical therapy. We identified 34 patients with SVG CTO. Of the 34 patients, 23 (68%) underwent successful SVG recanalization with stent implantation. An embolic protection device was used in 78% and 95% of stents implanted were drug-eluting stents. No in-hospital major adverse cardiac events occurred in the successful PCI group; one myocardial infarction occurred in the unsuccessful group. At follow-up (median 18.0 months, interquartile range 10.4 to 48.3), 1 case of myocardial infarction had occurred in the successful group. The in-stent restenosis rate was 68% (n = 13), of which 77% were focal, with target vessel revascularization in 61%. In conclusion, despite the relatively low procedural success rates, the clinical outcomes after successful PCI to SVG CTO with modern techniques were favorable. The repeat revascularization rates were high; however, graft patency was achievable in most after reintervention.
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Wiisanen ME, Abdel-Latif A, Mukherjee D, Ziada KM. Drug-Eluting Stents Versus Bare-Metal Stents in Saphenous Vein Graft Interventions. JACC Cardiovasc Interv 2010; 3:1262-73. [PMID: 21232720 DOI: 10.1016/j.jcin.2010.08.019] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2010] [Revised: 08/18/2010] [Accepted: 08/30/2010] [Indexed: 11/25/2022]
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Paradis JM, Bélisle P, Joseph L, Bertrand OF, DeLarochellière R, Déry JP, Larose E, Rodés-Cabau J, Rinfret S. Drug-eluting or bare metal stents for the treatment of saphenous vein graft disease: a Bayesian meta-analysis. Circ Cardiovasc Interv 2010; 3:565-76. [PMID: 21098743 DOI: 10.1161/circinterventions.110.949735] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Observational studies and randomized, controlled trials have yielded uncertain results regarding the benefits of drug-eluting stents (DES) for the treatment of saphenous vein graft (SVG) disease. The objective of this meta-analysis was to assess the cumulative evidence regarding the efficacy and effectiveness of DES to treat SVG compared with bare metal stent (BMS). METHODS AND RESULTS We conducted a bayesian hierarchical meta-analysis of all randomized, controlled trials and observational studies that compared clinical outcomes after DES or BMS placement in SVG disease. Our search resulted in 25 studies, cumulating 5755 patients. DES implantation was not associated with an increased risk of death (odds ratio [OR], 0.85; 95% credible intervals (CrI) [CrI], 0.62 to 1.21) or myocardial infarction (OR, 0.83; 95% CrI, 0.56 to 1.32), but wide CrIs preclude definitive conclusions. Target vessel revascularization (OR, 0.55; 95% CrI, 0.39 to 0.76) and target lesion revascularization (OR, 0.58; 95% CrI, 0.37 to 0.87) were both reduced by approximately 45% with DES. When combining these outcomes, the OR for major adverse cardiac events was reduced in patients treated with DES (OR, 0.62; 95% CrI, 0.46 to 0.81). Finally, the relative risk of stent thrombosis appeared lower with DES, although again the CrIs were very wide (OR, 0.54; 95% CrI, 0.13 to 1.39). CONCLUSIONS In this study-level meta-analysis, the largest ever reported and the first using bayesian methods, the use of DES for the treatment of SVG disease reduces target vessel revascularization and target lesion revascularization procedures compared with BMS. Although there is no evidence to date to suggest increased rates of mortality, myocardial infarction, or stent thrombosis, further data are needed to address this safety issue.
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Affiliation(s)
- Jean-Michel Paradis
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (Quebec Heart and Lung Institute), Quebec City, Canada
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Takagi H, Manabe H, Umemoto T. Drug-eluting versus bare metal stents for saphenous vein graft intervention. Am J Cardiol 2010; 106:1522-4. [PMID: 21059450 DOI: 10.1016/j.amjcard.2010.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 08/21/2010] [Indexed: 12/01/2022]
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Hakeem A, Helmy T, Munsif S, Bhatti S, Mazraeshahi R, Cilingiroglu M, Effat M, Leesar M, Arif I. Safety and efficacy of drug eluting stents compared with bare metal stents for saphenous vein graft interventions: A comprehensive meta-analysis of randomized trials and observational studies comprising 7,994 patients. Catheter Cardiovasc Interv 2010; 77:343-55. [PMID: 21328679 DOI: 10.1002/ccd.22720] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 06/22/2010] [Accepted: 06/26/2010] [Indexed: 11/06/2022]
Affiliation(s)
- Abdul Hakeem
- Division of Cardiovascular diseases, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio 45257-0542, USA.
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Navarese EP, Buffon A, De Luca G, De Servi S. Effectiveness and safety of drug-eluting stents in vein grafts: a meta-analysis. Am Heart J 2010; 160:e9-e11. [PMID: 20691822 DOI: 10.1016/j.ahj.2010.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Meier P, Brilakis ES, Corti R, Knapp G, Shishehbor MH, Gurm HS. Drug-eluting versus bare-metal stent for treatment of saphenous vein grafts: a meta-analysis. PLoS One 2010; 5:e11040. [PMID: 20548794 PMCID: PMC2883580 DOI: 10.1371/journal.pone.0011040] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 05/21/2010] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Saphenous 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 FINDINGS We 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). CONCLUSION DES 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.
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Affiliation(s)
- Pascal Meier
- University of Michigan Medical Center, Ann Arbor, Michigan, United States of America
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States of America
| | - Emmanouil S. Brilakis
- Division of Cardiovascular Diseases, Veterans Affairs North Texas Healthcare System, Dallas, Texas, United States of America
| | - Roberto Corti
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Guido Knapp
- Department of Statistics, TU Dortmund University, Dortmund, Germany
| | - Mehdi H. Shishehbor
- Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, United States of America
| | - Hitinder S. Gurm
- University of Michigan Medical Center, Ann Arbor, Michigan, United States of America
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States of America
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Sanchez-Recalde A, Jiménez Valero S, Moreno R, Barreales L, Lozano Í, Galeote G, Martín Reyes R, Calvo L, Lopez-Sendon J. Safety and efficacy of drug-eluting stents versus bare-metal stents in saphenous vein grafts lesions: a meta-analysis. EUROINTERVENTION 2010. [DOI: 10.4244/eijv6i1a22] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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