Document Detail

Drug-eluting or bare metal stents for the treatment of saphenous vein graft disease: a Bayesian meta-analysis.
MedLine Citation:
PMID:  21098743     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Observational studies and randomized, controlled trials have yielded uncertain results regarding the benefits of drug-eluting stents (DES) for the treatment of saphenous vein graft (SVG) disease. The objective of this meta-analysis was to assess the cumulative evidence regarding the efficacy and effectiveness of DES to treat SVG compared with bare metal stent (BMS).
METHODS AND RESULTS: We conducted a bayesian hierarchical meta-analysis of all randomized, controlled trials and observational studies that compared clinical outcomes after DES or BMS placement in SVG disease. Our search resulted in 25 studies, cumulating 5755 patients. DES implantation was not associated with an increased risk of death (odds ratio [OR], 0.85; 95% credible intervals (CrI) [CrI], 0.62 to 1.21) or myocardial infarction (OR, 0.83; 95% CrI, 0.56 to 1.32), but wide CrIs preclude definitive conclusions. Target vessel revascularization (OR, 0.55; 95% CrI, 0.39 to 0.76) and target lesion revascularization (OR, 0.58; 95% CrI, 0.37 to 0.87) were both reduced by approximately 45% with DES. When combining these outcomes, the OR for major adverse cardiac events was reduced in patients treated with DES (OR, 0.62; 95% CrI, 0.46 to 0.81). Finally, the relative risk of stent thrombosis appeared lower with DES, although again the CrIs were very wide (OR, 0.54; 95% CrI, 0.13 to 1.39).
CONCLUSIONS: In this study-level meta-analysis, the largest ever reported and the first using bayesian methods, the use of DES for the treatment of SVG disease reduces target vessel revascularization and target lesion revascularization procedures compared with BMS. Although there is no evidence to date to suggest increased rates of mortality, myocardial infarction, or stent thrombosis, further data are needed to address this safety issue.
Jean-Michel Paradis; Patrick Bélisle; Lawrence Joseph; Olivier F Bertrand; Robert DeLarochellière; Jean-Pierre Déry; Eric Larose; Josep Rodés-Cabau; Stéphane Rinfret
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Publication Detail:
Type:  Journal Article; Meta-Analysis     Date:  2010-11-23
Journal Detail:
Title:  Circulation. Cardiovascular interventions     Volume:  3     ISSN:  1941-7632     ISO Abbreviation:  Circ Cardiovasc Interv     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-12-15     Completed Date:  2011-03-31     Revised Date:  2011-06-07    
Medline Journal Info:
Nlm Unique ID:  101499602     Medline TA:  Circ Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  565-76     Citation Subset:  IM    
Institut Universitaire de Cardiologie et de Pneumologie de Québec (Quebec Heart and Lung Institute), Quebec City, Canada.
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MeSH Terms
Angioplasty, Balloon, Coronary*
Bayes Theorem
Drug-Eluting Stents*
Randomized Controlled Trials as Topic
Saphenous Vein / transplantation*
Reg. No./Substance:
Comment In:
Circ Cardiovasc Interv. 2011 Apr 1;4(2):e14; author reply e15   [PMID:  21505160 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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