Clinical outcomes of percutaneous interventions in saphenous vein grafts using drug-eluting stents compared to bare-metal stents

A comprehensive meta-analysisof all randomized clinical trials

Mahboob Alam, Salman J. Bandeali, Salim S. Virani, Hani M. Jneid, Saima A. Shahzad, K Ramanathan, Biswajit Kar, Neal S. Kleiman, Nasser Lakkis

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: Clinical outcomes of percutaneous coronary intervention (PCI) in patients with saphenous vein grafts (SVGs) remain poor despite the use of drug-eluting stents (DES). There is a disparity in clinical outcomes in SVG PCI based on various registries, and randomized clinical data remain scant. We conducted a meta-analysis of all existing randomized controlled trials (RCTS) comparing bare-metal stents (BMS) and DES in SVGPCIs. Hypothesis: PCI in patients with SVG disease using DES may reduce need for repeat revascularization without an excess mortality when 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 literature search between Janurary 1, 2003 and September 30, 2011 identified 4 RCTs (812 patients; DES = 416, BMS = 396). Summary odds ratio (OR) and 95% confidence interval (CI) were calculated using the random-effects model. The primary endpoint was all-cause mortality. Secondary outcomes included nonfatal myocardial infarction (MI), repeat revascularization, and major adverse cardiac events (MACE). These outcomes were assessed in a cumulative fashion at 30 days, 18 months, and 36 months. Results: There were no intergroup differences in baseline clinical and sociodemographic characteristics. At a median follow-up of 25 months, patients in the DES and BMS group had similar rates of death (OR: 1.63, 95% CI: 0.45-5.92), MI (OR; 0.83, 95% CI: 0.27-2.60), and MACE (OR: 0.58, 95% CI: 0.25-1.32). Patients treated with DES had lower rates of repeat revascularization (OR: 0.40, 95% CI: 0.22-0.75). Conclusions: In this comprehensive meta-analysis of all RCTs comparing clinical outcomes of PCI using DES vs BMS in patients with SVG disease, use of DES was associated with a reduction in rate of repeat revascularization and no difference in rates of all-cause death and MI.

Original languageEnglish (US)
Pages (from-to)291-296
Number of pages6
JournalClinical Cardiology
Volume35
Issue number5
DOIs
StatePublished - May 1 2012

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Drug-Eluting Stents
Saphenous Vein
Stents
Randomized Controlled Trials
Metals
Transplants
Percutaneous Coronary Intervention
Odds Ratio
Confidence Intervals
Meta-Analysis
Myocardial Infarction
Mortality
Registries
Cause of Death

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Clinical outcomes of percutaneous interventions in saphenous vein grafts using drug-eluting stents compared to bare-metal stents : A comprehensive meta-analysisof all randomized clinical trials. / Alam, Mahboob; Bandeali, Salman J.; Virani, Salim S.; Jneid, Hani M.; Shahzad, Saima A.; Ramanathan, K; Kar, Biswajit; Kleiman, Neal S.; Lakkis, Nasser.

In: Clinical Cardiology, Vol. 35, No. 5, 01.05.2012, p. 291-296.

Research output: Contribution to journalArticle

Alam, Mahboob ; Bandeali, Salman J. ; Virani, Salim S. ; Jneid, Hani M. ; Shahzad, Saima A. ; Ramanathan, K ; Kar, Biswajit ; Kleiman, Neal S. ; Lakkis, Nasser. / Clinical outcomes of percutaneous interventions in saphenous vein grafts using drug-eluting stents compared to bare-metal stents : A comprehensive meta-analysisof all randomized clinical trials. In: Clinical Cardiology. 2012 ; Vol. 35, No. 5. pp. 291-296.
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abstract = "Background: Clinical outcomes of percutaneous coronary intervention (PCI) in patients with saphenous vein grafts (SVGs) remain poor despite the use of drug-eluting stents (DES). There is a disparity in clinical outcomes in SVG PCI based on various registries, and randomized clinical data remain scant. We conducted a meta-analysis of all existing randomized controlled trials (RCTS) comparing bare-metal stents (BMS) and DES in SVGPCIs. Hypothesis: PCI in patients with SVG disease using DES may reduce need for repeat revascularization without an excess mortality when 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 literature search between Janurary 1, 2003 and September 30, 2011 identified 4 RCTs (812 patients; DES = 416, BMS = 396). Summary odds ratio (OR) and 95{\%} confidence interval (CI) were calculated using the random-effects model. The primary endpoint was all-cause mortality. Secondary outcomes included nonfatal myocardial infarction (MI), repeat revascularization, and major adverse cardiac events (MACE). These outcomes were assessed in a cumulative fashion at 30 days, 18 months, and 36 months. Results: There were no intergroup differences in baseline clinical and sociodemographic characteristics. At a median follow-up of 25 months, patients in the DES and BMS group had similar rates of death (OR: 1.63, 95{\%} CI: 0.45-5.92), MI (OR; 0.83, 95{\%} CI: 0.27-2.60), and MACE (OR: 0.58, 95{\%} CI: 0.25-1.32). Patients treated with DES had lower rates of repeat revascularization (OR: 0.40, 95{\%} CI: 0.22-0.75). Conclusions: In this comprehensive meta-analysis of all RCTs comparing clinical outcomes of PCI using DES vs BMS in patients with SVG disease, use of DES was associated with a reduction in rate of repeat revascularization and no difference in rates of all-cause death and MI.",
author = "Mahboob Alam and Bandeali, {Salman J.} and Virani, {Salim S.} and Jneid, {Hani M.} and Shahzad, {Saima A.} and K Ramanathan and Biswajit Kar and Kleiman, {Neal S.} and Nasser Lakkis",
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T1 - Clinical outcomes of percutaneous interventions in saphenous vein grafts using drug-eluting stents compared to bare-metal stents

T2 - A comprehensive meta-analysisof all randomized clinical trials

AU - Alam, Mahboob

AU - Bandeali, Salman J.

AU - Virani, Salim S.

AU - Jneid, Hani M.

AU - Shahzad, Saima A.

AU - Ramanathan, K

AU - Kar, Biswajit

AU - Kleiman, Neal S.

AU - Lakkis, Nasser

PY - 2012/5/1

Y1 - 2012/5/1

N2 - Background: Clinical outcomes of percutaneous coronary intervention (PCI) in patients with saphenous vein grafts (SVGs) remain poor despite the use of drug-eluting stents (DES). There is a disparity in clinical outcomes in SVG PCI based on various registries, and randomized clinical data remain scant. We conducted a meta-analysis of all existing randomized controlled trials (RCTS) comparing bare-metal stents (BMS) and DES in SVGPCIs. Hypothesis: PCI in patients with SVG disease using DES may reduce need for repeat revascularization without an excess mortality when 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 literature search between Janurary 1, 2003 and September 30, 2011 identified 4 RCTs (812 patients; DES = 416, BMS = 396). Summary odds ratio (OR) and 95% confidence interval (CI) were calculated using the random-effects model. The primary endpoint was all-cause mortality. Secondary outcomes included nonfatal myocardial infarction (MI), repeat revascularization, and major adverse cardiac events (MACE). These outcomes were assessed in a cumulative fashion at 30 days, 18 months, and 36 months. Results: There were no intergroup differences in baseline clinical and sociodemographic characteristics. At a median follow-up of 25 months, patients in the DES and BMS group had similar rates of death (OR: 1.63, 95% CI: 0.45-5.92), MI (OR; 0.83, 95% CI: 0.27-2.60), and MACE (OR: 0.58, 95% CI: 0.25-1.32). Patients treated with DES had lower rates of repeat revascularization (OR: 0.40, 95% CI: 0.22-0.75). Conclusions: In this comprehensive meta-analysis of all RCTs comparing clinical outcomes of PCI using DES vs BMS in patients with SVG disease, use of DES was associated with a reduction in rate of repeat revascularization and no difference in rates of all-cause death and MI.

AB - Background: Clinical outcomes of percutaneous coronary intervention (PCI) in patients with saphenous vein grafts (SVGs) remain poor despite the use of drug-eluting stents (DES). There is a disparity in clinical outcomes in SVG PCI based on various registries, and randomized clinical data remain scant. We conducted a meta-analysis of all existing randomized controlled trials (RCTS) comparing bare-metal stents (BMS) and DES in SVGPCIs. Hypothesis: PCI in patients with SVG disease using DES may reduce need for repeat revascularization without an excess mortality when 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 literature search between Janurary 1, 2003 and September 30, 2011 identified 4 RCTs (812 patients; DES = 416, BMS = 396). Summary odds ratio (OR) and 95% confidence interval (CI) were calculated using the random-effects model. The primary endpoint was all-cause mortality. Secondary outcomes included nonfatal myocardial infarction (MI), repeat revascularization, and major adverse cardiac events (MACE). These outcomes were assessed in a cumulative fashion at 30 days, 18 months, and 36 months. Results: There were no intergroup differences in baseline clinical and sociodemographic characteristics. At a median follow-up of 25 months, patients in the DES and BMS group had similar rates of death (OR: 1.63, 95% CI: 0.45-5.92), MI (OR; 0.83, 95% CI: 0.27-2.60), and MACE (OR: 0.58, 95% CI: 0.25-1.32). Patients treated with DES had lower rates of repeat revascularization (OR: 0.40, 95% CI: 0.22-0.75). Conclusions: In this comprehensive meta-analysis of all RCTs comparing clinical outcomes of PCI using DES vs BMS in patients with SVG disease, use of DES was associated with a reduction in rate of repeat revascularization and no difference in rates of all-cause death and MI.

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