We read with great interest a meta-analysis by Lee et al of drug-eluting stents (DESs) and bare metal stents (BMSs) for saphenous vein graft (SVG) intervention, which revealed that patients who underwent SVG intervention with DESs had lower mortality by 22% compared to the mortality rate of patients with BMSs (odds ratio 0.78, 95% confidence interval [CI] 0.59 to 1.02). The authors, however, combined unadjusted crude odds ratios calculated according to event rates for comparing patients with DESs to those with BMSs in not only randomized trials but also observational studies. Unlike for randomized trials, it will usually be appropriate to analyze adjusted rather than unadjusted risk estimates (i.e., analyses that attempt to control for confounding), which may require investigators to choose between alternative adjusted estimates reported for 1 study. We would like to perform here a meta-analysis combining adjusted risk estimates for follow-up death in randomized trials and observational studies.
Our comprehensive search identified 3 randomized trials and 7 observational studies that provided adjusted risk estimates for follow-up death. We abstracted 1 hazard ratio (HR) from 1 randomized trial, 5 adjusted HRs from observational studies, 2 risk ratios (RRs) from randomized trials, and 2 RRs from observational studies with matched controls. Pooled analysis of all 6 HRs and 4 RRs demonstrated no statistically significant difference in follow-up mortality between patients with DESs and those with BMSs who underwent SVG intervention (random-effects risk estimate 1.00, 95% CI 0.64 to 1.54, p = 0.98, p for heterogeneity = 0.03; Figure 1 ). When 6 HRs were pooled, there was no statistically significant difference in mortality between patients with DESs and those with BMSs (random-effects risk estimate 0.95, 95% CI 0.61 to 1.47, p = 0.82, p for heterogeneity = 0.05; Figure 1 ).
Despite the results of the meta-analysis by Lee et al, the results of our analysis suggest that patients who underwent SVG intervention with DESs may have similar mortality compared to the mortality rate of patients with BMSs.
References
- 1. Lee M.S., Yang T., Kandzari D.E., Tobis J.M., Liao H., and Mahmud E.: Comparison by meta-analysis of drug-eluting stents and bare metal stents for saphenous vein graft intervention. Am J Cardiol 2010; 105: pp. 1076-1082
- 2. Reeves B.C., Deeks J.J., Higgins J.P., and Wells G.A.: Including non-randomized studies. In Higgins J.P., and Green S. (eds): Cochrane Handbook for Systematic Reviews of Interventions, Version 5.0.2 (updated September 2009). The Cochrane Collaboration, 2009.
- 3. Brilakis E.S., Lichtenwalter C., de Lemos J.A., Roesle M., Obel O., Haagen D., Saeed B., Gadiparthi C., Bissett J.K., Sachdeva R., Voudris V.V., Karyofillis P., Kar B., Rossen J., Fasseas P., Berger P., and Banerjee S.: A randomized controlled trial of a paclitaxel-eluting stent versus a similar bare-metal stent in saphenous vein graft lesions the SOS (Stenting of Saphenous Vein Grafts) trial. J Am Coll Cardiol 2009; 53: pp. 919-928
- 4. Brodie B.R., Wilson H., Stuckey T., Nussbaum M., Laurent S., Bradshaw B., Humphrey A., Metzger C., Hermiller J., Krainin F., Juk S., Cheek B., Duffy P., and Simonton C.A.: Outcomes with drug-eluting versus bare-metal stents in saphenous vein graft intervention results from the STENT (Strategic Transcatheter Evaluation of New Therapies) group. JACC Cardiovasc Interv 2009; 2: pp. 1105-1112
- 5. Goswami N.J., Gaffigan M., Berrio G., Plessa A.L., Pfeiffer A.M., Markwell S.J., and Mishkel G.J.: Long-term outcomes of drug-eluting stents versus bare-metal stents in saphenous vein graft disease: results from the Prairie “Real World” Stent Registry. Catheter Cardiovasc Interv 2010; 75: pp. 93-100
- 6. Latib A., Ferri L., Ielasi A., Cosgrave J., Godino C., Bonizzoni E., Romagnoli E., Chieffo A., Valgimigli M., Penzo C., Carlino M., Michev I., Sangiorgi G.M., Montorfano M., Airoldi F., and Colombo A.: Comparison of the long-term safety and efficacy of drug-eluting and bare-metal stent implantation in saphenous vein grafts. Circ Cardiovasc Interv 2010; 3: pp. 249-256
- 7. Shishehbor M.H., Hawi R., Singh I.M., Tuzcu E.M., Bhatt D.L., Ellis S.G., and Kapadia S.R.: Drug-eluting versus bare-metal stents for treating saphenous vein grafts. Am Heart J 2009; 158: pp. 637-643
- 8. van Twisk P.H., Daemen J., Kukreja N., van Domburg R.T., and Serruys P.W.: Four-year safety and efficacy of the unrestricted use of sirolimus- and paclitaxel-eluting stents in coronary artery bypass grafts. Eurointervention 2008; 4: pp. 311-317
- 9. Jeger R.V., Schneiter S., Kaiser C., Bonetti P.O., Brunner-La Rocca H., Handke M., Osswald S., Buser P.T., and Pfisterer M.E.: Drug-eluting stents compared with bare metal stents improve late outcome after saphenous vein graft but not after large native vessel interventions. Cardiology 2009; 112: pp. 49-55
- 10. Vermeersch P., Agostoni P., Verheye S., Van den Heuvel P., Convens C., Van den Branden F., and Van Langenhove G.: Increased late mortality after sirolimus-eluting stents versus bare-metal stents in diseased saphenous vein grafts: results from the randomized DELAYED RRISC Trial. J Am Coll Cardiol 2007; 50: pp. 261-267
- 11. Ellis S.G., Kandzari D., Kereiakes D.J., Pichard A., Huber K., Resnic F., Yakubov S., Callahan K., Borgman M., and Cohen S.A.: Utility of sirolimus-eluting Cypher stents to reduce 12-month target vessel revascularization in saphenous vein graft stenoses: results of a multicenter 350-patient case-control study. J Invasive Cardiol 2007; 19: pp. 404-409
- 12. Wöhrle J., Nusser T., Kestler H.A., Kochs M., and Hombach V.: Comparison of the slow-release polymer-based paclitaxel-eluting Taxus-Express stent with the bare-metal Express stent for saphenous vein graft interventions. Clin Res Cardiol 2007; 96: pp. 70-76
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
