Drug-eluting versus bare-metal stent for treatment of saphenous vein grafts: a meta-analysis.

<h4>Background</h4>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 literatu...

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Autores principales:	Pascal Meier, Emmanouil S Brilakis, Roberto Corti, Guido Knapp, Mehdi H Shishehbor, Hitinder S Gurm
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2010
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/b8ba152455cf4637a52eb280935137d5
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spelling	oai:doaj.org-article:b8ba152455cf4637a52eb280935137d52021-12-02T20:21:01ZDrug-eluting versus bare-metal stent for treatment of saphenous vein grafts: a meta-analysis.1932-620310.1371/journal.pone.0011040https://doaj.org/article/b8ba152455cf4637a52eb280935137d52010-06-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/20548794/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>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.<h4>Methodology/principal findings</h4>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).<h4>Conclusion</h4>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.Pascal MeierEmmanouil S BrilakisRoberto CortiGuido KnappMehdi H ShishehborHitinder S GurmPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 5, Iss 6, p e11040 (2010)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Pascal Meier Emmanouil S Brilakis Roberto Corti Guido Knapp Mehdi H Shishehbor Hitinder S Gurm Drug-eluting versus bare-metal stent for treatment of saphenous vein grafts: a meta-analysis.
description	<h4>Background</h4>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.<h4>Methodology/principal findings</h4>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).<h4>Conclusion</h4>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.
format	article
author	Pascal Meier Emmanouil S Brilakis Roberto Corti Guido Knapp Mehdi H Shishehbor Hitinder S Gurm
author_facet	Pascal Meier Emmanouil S Brilakis Roberto Corti Guido Knapp Mehdi H Shishehbor Hitinder S Gurm
author_sort	Pascal Meier
title	Drug-eluting versus bare-metal stent for treatment of saphenous vein grafts: a meta-analysis.
title_short	Drug-eluting versus bare-metal stent for treatment of saphenous vein grafts: a meta-analysis.
title_full	Drug-eluting versus bare-metal stent for treatment of saphenous vein grafts: a meta-analysis.
title_fullStr	Drug-eluting versus bare-metal stent for treatment of saphenous vein grafts: a meta-analysis.
title_full_unstemmed	Drug-eluting versus bare-metal stent for treatment of saphenous vein grafts: a meta-analysis.
title_sort	drug-eluting versus bare-metal stent for treatment of saphenous vein grafts: a meta-analysis.
publisher	Public Library of Science (PLoS)
publishDate	2010
url	https://doaj.org/article/b8ba152455cf4637a52eb280935137d5
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Drug-eluting versus bare-metal stent for treatment of saphenous vein grafts: a meta-analysis.

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