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Drug-eluting stents better than bare metal for saphenous vein graft interventions

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Drug-eluting stents in saphenous vein grafts have a lower risk of revascularization than bare-metal stents, according to a meta-analysis of data on nearly 3500 patients.



The study, by Dr. Michael S. Lee and colleagues, also showed nonsignificant trends toward lower rates of myocardial infarction and mortality with drug-eluting stents.



Whereas a November 2009 meta-analysis looking at the same issue found no difference between the two types of stents, its authors analyzed data only from the two existing randomized trials (see Reuters Health story of November 13, 2009). The current analysis included those two trials as well as 17 observational studies from 2003 to 2009.



Overall, 1489 patients received sirolimus-eluting stents (Cypher, Cordis/Johnson & Johnson) and/or paclitaxel-eluting stents (Taxus Express, Boston Scientific; and V-Flex Plus, Cook). Another 1931 received bare-metal stents. The mean length of follow-up was 20 months.



Dr. Lee, from the David Geffen School of Medicine in Los Angeles, and his coauthors reported online February 22 in the American Journal of Cardiology that drug-eluting stents reduced the risk of clinically driven target vessel revascularization by a statistically significant 41%.



Patients with drug-eluting stents also had a nonsignificant decrease in mortality (odds ratio 0.78) and myocardial infarction (OR 0.69).



Nine studies did not report stent thrombosis, four studies had no reported cases, and six found no significant difference in risk with drug-eluting vs bare-metal stents.



The authors point out that their study-level meta-analysis lacked patient-level data, preventing adjustment with propensity score analysis. Also, the observational studies were subject to “publication bias, patient selection, confounders, and the tendency to overestimate the treatment effects.”



Also, they say, longer follow-up will be needed to see if the benefits of drug-eluting stents hold up over time.



Nevertheless, the researchers conclude, use of drug-eluting stents for saphenous vein grafts “provides superior clinical outcomes.”



Reference:


Am J Cardiol 2010.