Drug Eluting Stents versus Bare Metal Stents for Cardiac Allograft Vasculopathy: A Systematic Review and Meta-Analysis

J. Maning, V. Blumer, S. Chaparro

Research output: Contribution to journalArticle

Abstract

PURPOSE: Cardiac allograft vasculopathy (CAV) is one of the leading causes of late mortality among heart transplant recipients. Retransplantation, although considered the only definitive therapy, is not a feasible option for most patients. Percutaneous coronary intervention (PCI) with drug eluting stents (DES) or bare metal stents (BMS) has become a palliative, more accessible therapy. We conducted a systematic review and meta-analysis to investigate clinical outcomes of DES vs BMS. METHODS: We searched Medline, Embase, and the Cochrane Library for studies evaluating therapeutic options for CAV, in particular publications comparing DES vs BMS. We identified 3112 potential eligible publications. Outcomes were compared using the random-effects model and heterogenicity examined via X2 ανδ I2 statistics. RESULTS: Eight retrospective studies were included in our analysis for a total of 469 patients who underwent PCI with stenting for CAV, resulting in treatment of 735 lesions. DES was associated with less in-stent restenosis (ISR) at 1-year (OR 0.37 95% CI 0.21-0.64, p = 0.0004) and less need for revascularization after initial intervention (OR 0.23 95% CI 0.12-0.47, p < 0.0001). Of the 431 patients with clinical follow-up, 117 (27%) patients died by the end of the follow-up period. Retransplantation for progressive vasculopathy was reported for 30 patients. CONCLUSION: Compared to PCI with BMS for cardiac allograft vasculopathy, the use of DES offers superior angiographic outcomes at follow-up. The use of DES is associated with sustained reductions in the incidence of in-stent restenosis and revascularization.

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

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