Drug eluting versus bare metal stents in saphenous vein graft intervention

An updated comprehensive meta-analysis of randomized trials

Sukhdeep Bhogal, Hemang B. Panchal, Jayant Bagai, Subhash Banerjee, Emmanouil S Brilakis, Debabrata Mukherjee, Gautam Kumar, Madhan Shanmugasundaram, Timir K. Paul

Research output: Contribution to journalArticle

Abstract

Background: Drug eluting stents (DES) are preferred over bare metal stents (BMS) for native coronary artery revascularization unless contraindicated. However, the preferred stent choice for saphenous venous graft (SVG) percutaneous coronary interventions (PCI) is unclear due to conflicting results. Methods: PubMed, Clinical trials registry and the Cochrane Center Register of Controlled Trials were searched through June 2018. Seven studies (n = 1639) comparing DES versus BMS in SVG-PCI were included. Endpoints were major adverse cardiac events (MACE), cardiovascular mortality, all-cause mortality, myocardial infarction (MI), target vessel revascularization (TVR), target lesion revascularization (TLR), in-stent thrombosis, binary in-stent restenosis, and late lumen loss (LLL). Results: Overall, during a mean follow up of 32.1 months, there was no significant difference in the risk of MACE, cardiovascular mortality, all-cause mortality, MI, stent thrombosis, TVR and TLR between DES and BMS. However, short-term follow up (mean 11 months) showed lower rate of MACE (OR 0.66 [0.51, 0.85]; p = 0.002), TVR (OR 0.47 [0.23, 0.97]; p = 0.04) and binary in-stent restenosis (OR 0.14 [0.06, 0.37]; p < 0.0001) in DES as compared with BMS. This benefit was lost on long-term follow up with a mean follow up 35.5 months. Conclusion: In this meta-analysis of SVG-PCI, DES use was associated with similar MACE, cardiovascular mortality, all-cause mortality, MI, in-stent thrombosis, TVR and TLR compared with BMS during long-term follow up. There was high incidence of MACE noted in both DES and BMS suggesting a need for exploring novel strategies to treat SVG disease to improve clinical outcomes.

Original languageEnglish (US)
JournalCardiovascular Revascularization Medicine
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Saphenous Vein
Stents
Meta-Analysis
Metals
Transplants
Drug-Eluting Stents
Pharmaceutical Preparations
Mortality
Percutaneous Coronary Intervention
Thrombosis
Myocardial Infarction
PubMed
Registries
Coronary Vessels
Clinical Trials

Keywords

  • Bare metal stent
  • Coronary intervention
  • Drug eluting stent
  • Major adverse cardiovascular events
  • Saphenous vein graft

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Drug eluting versus bare metal stents in saphenous vein graft intervention : An updated comprehensive meta-analysis of randomized trials. / Bhogal, Sukhdeep; Panchal, Hemang B.; Bagai, Jayant; Banerjee, Subhash; Brilakis, Emmanouil S; Mukherjee, Debabrata; Kumar, Gautam; Shanmugasundaram, Madhan; Paul, Timir K.

In: Cardiovascular Revascularization Medicine, 01.01.2018.

Research output: Contribution to journalArticle

Bhogal, Sukhdeep ; Panchal, Hemang B. ; Bagai, Jayant ; Banerjee, Subhash ; Brilakis, Emmanouil S ; Mukherjee, Debabrata ; Kumar, Gautam ; Shanmugasundaram, Madhan ; Paul, Timir K. / Drug eluting versus bare metal stents in saphenous vein graft intervention : An updated comprehensive meta-analysis of randomized trials. In: Cardiovascular Revascularization Medicine. 2018.
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abstract = "Background: Drug eluting stents (DES) are preferred over bare metal stents (BMS) for native coronary artery revascularization unless contraindicated. However, the preferred stent choice for saphenous venous graft (SVG) percutaneous coronary interventions (PCI) is unclear due to conflicting results. Methods: PubMed, Clinical trials registry and the Cochrane Center Register of Controlled Trials were searched through June 2018. Seven studies (n = 1639) comparing DES versus BMS in SVG-PCI were included. Endpoints were major adverse cardiac events (MACE), cardiovascular mortality, all-cause mortality, myocardial infarction (MI), target vessel revascularization (TVR), target lesion revascularization (TLR), in-stent thrombosis, binary in-stent restenosis, and late lumen loss (LLL). Results: Overall, during a mean follow up of 32.1 months, there was no significant difference in the risk of MACE, cardiovascular mortality, all-cause mortality, MI, stent thrombosis, TVR and TLR between DES and BMS. However, short-term follow up (mean 11 months) showed lower rate of MACE (OR 0.66 [0.51, 0.85]; p = 0.002), TVR (OR 0.47 [0.23, 0.97]; p = 0.04) and binary in-stent restenosis (OR 0.14 [0.06, 0.37]; p < 0.0001) in DES as compared with BMS. This benefit was lost on long-term follow up with a mean follow up 35.5 months. Conclusion: In this meta-analysis of SVG-PCI, DES use was associated with similar MACE, cardiovascular mortality, all-cause mortality, MI, in-stent thrombosis, TVR and TLR compared with BMS during long-term follow up. There was high incidence of MACE noted in both DES and BMS suggesting a need for exploring novel strategies to treat SVG disease to improve clinical outcomes.",
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AU - Bagai, Jayant

AU - Banerjee, Subhash

AU - Brilakis, Emmanouil S

AU - Mukherjee, Debabrata

AU - Kumar, Gautam

AU - Shanmugasundaram, Madhan

AU - Paul, Timir K.

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AB - Background: Drug eluting stents (DES) are preferred over bare metal stents (BMS) for native coronary artery revascularization unless contraindicated. However, the preferred stent choice for saphenous venous graft (SVG) percutaneous coronary interventions (PCI) is unclear due to conflicting results. Methods: PubMed, Clinical trials registry and the Cochrane Center Register of Controlled Trials were searched through June 2018. Seven studies (n = 1639) comparing DES versus BMS in SVG-PCI were included. Endpoints were major adverse cardiac events (MACE), cardiovascular mortality, all-cause mortality, myocardial infarction (MI), target vessel revascularization (TVR), target lesion revascularization (TLR), in-stent thrombosis, binary in-stent restenosis, and late lumen loss (LLL). Results: Overall, during a mean follow up of 32.1 months, there was no significant difference in the risk of MACE, cardiovascular mortality, all-cause mortality, MI, stent thrombosis, TVR and TLR between DES and BMS. However, short-term follow up (mean 11 months) showed lower rate of MACE (OR 0.66 [0.51, 0.85]; p = 0.002), TVR (OR 0.47 [0.23, 0.97]; p = 0.04) and binary in-stent restenosis (OR 0.14 [0.06, 0.37]; p < 0.0001) in DES as compared with BMS. This benefit was lost on long-term follow up with a mean follow up 35.5 months. Conclusion: In this meta-analysis of SVG-PCI, DES use was associated with similar MACE, cardiovascular mortality, all-cause mortality, MI, in-stent thrombosis, TVR and TLR compared with BMS during long-term follow up. There was high incidence of MACE noted in both DES and BMS suggesting a need for exploring novel strategies to treat SVG disease to improve clinical outcomes.

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KW - Drug eluting stent

KW - Major adverse cardiovascular events

KW - Saphenous vein graft

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