Abstract 20323: Bare Metal Stents versus Drug Eluting Stents in Saphenous Vein Grafts: A Systematic Review of Prospective and Retrospective Studies
Background: Drug eluting stents (DES) have led to significant advancement but there are limits of evidence to their use in saphenous vein grafts (SVG). SVG disease after coronary bypass is a common predicament and long-term follow-up studies quote 10 year SVG reocclusion rates of 40%. Bare metal stents (BMS) have been used as a standard approach to SVG failure, however these have been associated with restenosis rates of 50% at 6 month follow-up. Hence, the use of DES in SVG disease has been studied in prospective and retrospective trials. Our project is a systematic review of BMS versus DES in SVG disease in which we conducted summary analysis and interpretation of the current evidence.
Methods: A literature search was conducted through MEDLINE and PubMed. The initial search yielded 63 studies, 19 of which met our final inclusion criteria; seven prospective trials and 12 retrospective analyses.
Results: A total of 4,016 patients are described. Approximately 54% had BMS, 46% had DES, and a majority were males. The mean SVG age was 11 years. Greater than 25% were diabetics. The seven prospective trials had variable periods of follow-up ranging from 6–36 months. The 6 month follow-up studies demonstrated no difference in cardiac death but showed significantly lower rates of target vessel revascularization (TVR) and target lesion revascularization (TLR) in the DES population. However, with prolonged follow-up at the 12–18 month periods, there was no significant difference between BMS versus DES in TVR/TLR, while the 36 month period actually demonstrated significantly increased cardiac deaths amongst the DES population with no difference in TVR/TLR between the two groups. Of the 12 retrospective analyses, while few studies reported significantly fewer restenosis events amongst the DES group irrespective of the follow-up period, the overarching results demonstrate no significant difference in cardiac death, TVR/TLR, or restenosis at 6–36 months.
Conclusions: These prospective and retrospective data demonstrate no significant difference between BMS versus DES in SVG in long-term follow-up. While short-term follow-up of 6–9 months may demonstrate fewer TLR/TVR rates, this may come at the expense of increased cardiac death rates in the DES group at 36 months follow-up.
- © 2010 by American Heart Association, Inc.