Twenty studies (5,296 participants) were included; two RCTs (165 participants) and 18 registry studies. Mean follow-up ranged from six to 48 months (mean 23 months). Baseline characteristics were similar between groups in all studies.
Mortality rates ranged from 0% to 28.9% in the drug-eluting stents group and from 0% to 29.2% in the bare-metal stents group. The use of drug-eluting stents was associated with a decreased risk of mortality compared with bare-metal stents in patients undergoing percutaneous intervention for saphenous vein graft (OR 0.68, 95% CI 0.53 to 0.88; 20 studies). There was little evidence of heterogeneity (p=0.14; I2=26.3%). There was no association between length of follow-up and mortality outcomes. Restriction of the analysis to RCTs showed no association with drug-eluting stents use and mortality (OR 6.7, 95% CI 0.62 to 74.14; two RCTs).
The use of drug-eluting stents was associated with a reduced risk of major adverse coronary events (OR 0.64, 95% CI 0.51 to 0.82; 19 studies), target vessel revascularisation (OR 0.57, 95% CI 0.41 to 0.80; 16 studies) and target lesion revascularisation (OR 0.60, 95% CI 0.43 to 0.83; 13 studies). There was strong evidence of heterogeneity (p<0.001; I2=62.4%) for the major adverse coronary events studies; heterogeneity was not reported for target vessel revascularisation or target lesion revascularisation.
Restriction of the analysis to the RCTs showed no association with drug-eluting stents use and major adverse coronary events (OR 1.10, 95% CI 0.34 to 3.57; two RCTs). There was no association between drug-eluting stents use and myocardial infarction (16 studies) or stent thrombosis (eight studies).