A Meta-analysis Comparing Various anti-proliferative Agent-based Drug-eluting Stents with Bare Metal Stents in Saphenous Vein Graft Interventions

Background:
Randomized clinical trials (RCTs) comparing drug-eluting stents (DESs) with bare metal stents (BMSs) for SVG intervention have yielded conflicting results. However, a critical appraisal of those RCTs (including subgroup analyses from the recently reported longest follow-up from the largest RCT [ISAR-CABG trial]) suggest that some antiproliferative drugs are more effective in SVG lesions than others.

Methods:
We performed a traditional meta-analysis using moderator analyses and a Bayesian network meta-analysis to compare the efficacy of various stent platforms including limus-based DESs, paclitaxel-based DESs, and BMSs. We used the longest follow-up data available from each trial.

Results:
Data from 5 RCTs involving 1321 patients were included. In the direct comparison meta-analysis, paclitaxel-based DESs decreased risks for MACEs, MI, and TVR compared to BMSs, but limus-based DESs did not (Figures A-C). Similarly, in the network meta-analysis, paclitaxel-based DESs were associated with lower risks of MACEs, MI, and TVR compared to both limus-based DESs and BMSs, but no difference was found between limus-based DESs and BMSs (Figures D-F). Risks for death and stent thrombosis were similar between platforms.

Conclusions:
For SVG interventions, paclitaxel-based DESs associated with better outcomes compared to limus-based DESs and BMSs. Further RCTs with enough power needed to the compare the efficacy of various antiproliferative agent-based DESs and BMSs.