Nairooz Ramez, Saad Marwan, Dhillon Ashwat S, Yousaf Haroon, Awar Lena, Mehra Anilkumar, Matthews Ray V, Shavelle David, Clavijo Leonardo
University of Southern California, Los Angeles, CA, United States of America.
University of Arkansas for Medical Sciences, Little Rock, AR, United States of America.
Cardiovasc Revasc Med. 2018 Dec;19(8):951-955. doi: 10.1016/j.carrev.2018.07.022. Epub 2018 Jul 25.
The optimal stent for use in saphenous vein graft (SVG) intervention is still debatable. Multiple randomized trials have compared drug-eluting stents (DES) to bare metal stents (BMS) in SVG interventions with conflicting results.
Authors searched the online databases for randomized controlled trials (RCTs) comparing DES to BMS in SVG percutaneous coronary interventions (PCI). We performed a meta-analysis using a random effects model to calculate the odds ratio for outcomes of interest.
Authors studied six RCTs that included 1592 patients undergoing PCI of SVG. The mean follow up was 42 months. Patients mean age was the same in both groups: 70.3 years in the DES group (approximately 93.3% male) and 70.3 years in the BMS group (approximately 93.8% male). Vein graft age was 13.4 years in the DES PCI arm vs. 13.4 years in the BMS PCI arm. Four of the six trials reported data on embolic protection device use: 67% (303/452) in the DES arm vs. 67.9% (309/455) in the BMS arm. The primary outcome of long-term all-cause mortality was not different between DES vs. BMS (15.2% vs. 14.1%, OR 1.12, 95% CI 0.67-1.88; P = 0.66). Secondary outcomes were also similar between DES and BMS: major adverse cardiovascular events (31.6% vs. 33.1%, OR 0.79, 95% CI 0.45-1.38; P = 0.41); cardiac death (9% vs. 8.6%, OR 1.12, 95% CI 0.55-2.30; P = 0.75); myocardial infarction (8% vs. 9.5%, OR 0.84, 95% CI 0.47-1.51; P = 0.57); target lesion revascularization (16.4% vs. 14.4%, OR 0.98, 95% CI 0.50-1.92; P = 0.95); and target vessel revascularization (19% vs. 19.4%, OR 0.75, 95% CI 0.41-1.34; P = 0.33).
At a mean follow-up of 42 months, no difference was observed in clinical outcomes between DES and BMS in SVG interventions.
用于隐静脉移植血管（SVG）介入治疗的最佳支架仍存在争议。多项随机试验在SVG介入治疗中对比了药物洗脱支架（DES）和裸金属支架（BMS），结果相互矛盾。
作者检索了在线数据库，查找在SVG经皮冠状动脉介入治疗（PCI）中对比DES和BMS的随机对照试验（RCT）。我们采用随机效应模型进行荟萃分析，以计算感兴趣结局的比值比。
作者研究了6项RCT，共纳入1592例行SVG PCI的患者。平均随访时间为42个月。两组患者的平均年龄相同：DES组为70.3岁（男性约占93.3%），BMS组为70.3岁（男性约占93.8%）。DES PCI组的移植血管使用年限为13.4年，BMS PCI组为13.4年。6项试验中的4项报告了有关使用栓子保护装置的数据：DES组为67%（303/452），BMS组为67.9%（309/455）。DES与BMS相比，长期全因死亡率的主要结局无差异（15.2%对14.1%，比值比1.12，95%置信区间0.67 - 1.88；P = 0.66）。DES和BMS的次要结局也相似：主要不良心血管事件（31.6%对33.1%，比值比0.79，95%置信区间0.45 - 1.38；P = 0.41）；心源性死亡（9%对8.6%，比值比1.12，95%置信区间0.55 - 2.30；P = 0.75）；心肌梗死（8%对9.5%，比值比0.84，95%置信区间0.47 - 1.51；P = 0.57）；靶病变血运重建（16.4%对14.4%，比值比0.98，95%置信区间0.50 - 1.92；P = 0.95）；以及靶血管血运重建（19%对19.4%，比值比0.75，95%置信区间0.41 - 1.34；P = 0.33）。
在平均随访42个月时，SVG介入治疗中DES和BMS的临床结局未观察到差异。
