Abstract 9844: Clinical Outcomes of Saphenous Vein Graft Interventions Using Drug Eluting Stents Compared with Bare Metal Stents: A Comprehensive Meta-Analysis of All Randomized Clinical Trials
Introduction: Clinical outcomes of PCI in patients with saphenous vein grafts (SVG) remain poor despite the use of drug eluting stents. There is disparity in clinical outcomes in SVG PCI based on various registries while randomized data remains scant.
Hypothesis: In the setting of an earlier randomized trial showing higher mortality in patients who underwent DES implantation for SVG disease we sought to assess whether DES use in SVG interventions will improve short and intermediate-term clinical outcomes compared to BMS.
Methods: An aggregate data meta-analysis of clinical outcomes in RCTs comparing PCI with DES vs. BMS for SVGs reporting at least 12 months of follow-up was performed. A search of Medline and conference proceedings between 01/2003 and 05/2011 identified 4 RCTs enrolling 812 patients (416 in DES and 396 in BMS arms). Summary odds ratios & 95% confidence intervals were calculated using the random-effects model. Review Manager Version 5.1 (The Cochrane Collaboration) was used for data analyses. Primary endpoint was all cause mortality. Secondary outcomes included non-fatal myocardial infarction (MI), repeat revascularization (i.e. target vessel revascularization [TVR] or target lesion revascularization [TLR]), and MACE (composite endpoint of death, MI and TLR/TVR). These outcomes were assessed in cumulative fashion at 30 days, 18 months and 36 months.
Results: Overall, there were no inter-group differences in baseline clinical and socio-demographic characteristics. Following a median follow-up of 25 months (range 12 - 35months), patients in the DES and BMS group had similar rates of death, MI and MACE. Patients in the DES arm had significantly lower rates of repeat revascularization OR = 0.40, 95% CI 0.22 - 0.75). Table I provides details of the meta-analysis outcomes at various follow-up periods.
Conclusions: Use of DES in SVG interventions is associated with significant reduction in rate of repeat revascularization without an excess in mortality.
- © 2011 by American Heart Association, Inc.