Cardiologia 2, Ospedale Maggiore della Carità, Novara, Italy.
Circ J. 2011;75(2):280-9. doi: 10.1253/circj.cj-10-0186. Epub 2010 Dec 14.
Evidence supporting the use of drug-eluting stents (DES) in saphenous vein graft (SVG) disease is uncertain. Previous studies have suggested that DES might reduce the re-intervention rate in SVG disease, with conflicting data on mortality. Thus, a meta-analysis was performed to compare outcomes of DES vs. bare metal stent (BMS) in SVG disease.
Medline and Web databases were searched for studies comparing DES and BMS for SVG disease, reporting rates of overall mortality, target vessel revascularization (TVR) and myocardial infarction (MI) with a follow-up of ≥6 months. The meta-analysis included 23 studies (7,090 patients). Compared with BMS, DES-treated patients had lower rates of TVR (odds ratio (OR), 0.53; confidence interval (CI), 0.39-0.72; P<0.0001) and overall mortality (OR, 0.63; CI, 0.40-0.99; P=0.05), but similar rates of MI (OR, 0.92; CI, 0.64-1.33; P=0.7). Subgroup analysis highlighted differences between non-randomized studies, in which DES improved mortality rates, and randomized trials, in which benefit from DES was not evident. Meta-regression analysis showed that DES were more effective in the presence of older grafts and type 2 diabetes.
The present meta-analysis showed that, in SVG disease, DES significantly reduced TVR, but did not provide clear benefits on mortality and MI, with an opposite direction of results in mortality observed from randomized and observational data.
药物洗脱支架（DES）在静脉桥血管（SVG）疾病中的应用证据尚不确定。先前的研究表明，DES 可能降低 SVG 疾病中的再介入率，但死亡率的数据存在冲突。因此，进行了一项荟萃分析，以比较 DES 与金属裸支架（BMS）在 SVG 疾病中的疗效。
检索 Medline 和 Web 数据库，以比较 DES 和 BMS 治疗 SVG 疾病的研究，报告总死亡率、靶血管血运重建（TVR）和心肌梗死（MI）的发生率，随访时间≥6 个月。荟萃分析纳入了 23 项研究（7090 例患者）。与 BMS 相比，DES 治疗组的 TVR 发生率较低（比值比（OR），0.53；95%置信区间（CI），0.39-0.72；P<0.0001）和总死亡率（OR，0.63；95%CI，0.40-0.99；P=0.05），但 MI 发生率相似（OR，0.92；95%CI，0.64-1.33；P=0.7）。亚组分析突出了非随机研究和随机试验之间的差异，前者表明 DES 改善了死亡率，后者则表明 DES 没有明显获益。Meta 回归分析显示，DES 在陈旧的移植物和 2 型糖尿病患者中更有效。
本荟萃分析表明，在 SVG 疾病中，DES 显著降低了 TVR，但在死亡率和 MI 方面没有明显获益，随机和观察性数据显示死亡率的结果方向相反。
