Abstract 4599: A Comparison of Drug Eluting Stents versus Bare Metal Stents in Saphenous Vein Graft PCI Outcomes: A Meta-Analysis of 18 Studies
Both large multi centre trials and registry studies have demonstrated that PCI with drug eluting stents (DES) is associated with reduced revascularization and MACE rates compared to bare metal stents (BMS) in native coronary vessels. Optimal PCI treatment of saphenous vein graft (SVG) lesions remains unclear despite SVG procedures representing up to 10% of PCI cases. In the recent randomized DELAYED RRISC trial, DES use was associated with a greater mortality than BMS for SVG PCI with no differences in revascularization rates. We therefore performed a meta-analysis to compare outcomes between BMS and DES in SVG PCI. A search of Medline (1966–2009) and conference proceedings (2004–2009) from AHA, ACC, TCT and ESC for all relevant studies comparing mortality, revascularization and MACE outcomes in DES vs BMS in SVG PCI was performed. A Random effects model was used for the meta-analysis. A total of 18 studies were identified from 2005 to 2009 enrolling a total of 3434 patients. Mortality in the DES group was 112/1411 (7.9%) and in the BMS group was 172/1739 (9.9%). Meta-analysis of these 18 trials revealed no difference in mortality between the 2 stent types, Odds Ratio (OR) 0.80, 95% CI 0.61–1.05, P>0.05. In contrast, MACE (OR 0.52; 95% CI 0.40–0.69; P<0.0001), Total Vessel Revascularisation (0.51; 95% CI 0.37–0.61; P<0.0001) and Total Lesion Revascularisation (OR 0.46; 95% CI 0.37–57; P<0.0001) were significantly decreased in the patients in which DES were used compared to BMS. In conclusion, in the first meta-analysis performed to date comparing the use of BMS and DES in SVG PCI of 18 studies involving 3434 patients we have observed a reduction in MACE and re-vascularisation rates in patients receiving DES compared to BMS use. In agreement with previous meta-analyses of DES vs BMS studies in native coronary vessels, we have observed no differences in mortality outcomes in SVG PCI. Despite suggestions of delayed endothelial healing after DES implantation in SVG in addition to local pro-thrombotic conditions which raise concerns regarding potential increased risks of stent thrombosis associated with DES use in SVG PCI our meta-analysis suggests DES use to be safe in SVG PCI and associated with reduced MACE rates driven primarily through a reduction in revascularization.