Effectiveness of the sirolimus-eluting stent in the treatment of patients with a prior history of coronary artery bypass graft surgery.
OBJECTIVE
Percutaneous coronary intervention in patients with a history of previous coronary artery bypass grafting (CABG) is associated with an increased rate of subsequent adverse events compared to those without prior CABG. We evaluated the impact of utilizing the sirolimus-eluting stent (SES) in this high-risk population.


METHODS
Since April 2002, SES implantation was utilized as the default strategy for all percutaneous procedures in our hospital. Consecutive patients with a history of previous CABG and de novo lesions (n=47) treated exclusively with SES, were compared to 66 patients who received bare stents in the 6-month period just before SES introduction.


RESULTS
There were no significant differences between the groups (SES and bare stent) with respect to baseline clinical or lesion characteristics. The only difference between the groups related to the nominal diameter of stent utilized, which was smaller in the SES group than the bare stent group. (The maximum diameter of SES available was 3.0 mm). At 1 year, the cumulative incidence of major adverse events (defined as death, myocardial infarction, or target vessel revascularization) was significantly lower in the SES group than the bare stent group [8.5 versus 30.3%, hazard ratio 0.37 (95% confidence interval 0.15-0.91); P=0.03].


CONCLUSIONS
The utilization of the sirolimus-eluting stent for percutaneous intervention in a high-risk population with a history of previous CABG surgery is associated with a significant reduction in the rate of major adverse cardiac events at 1 year.
Hoye
Angela
A
Department of Cardiology, Thoraxcenter, Erasmus Medical Centre, Rotterdam, The Netherlands.
Lemos
Pedro A
PA
Arampatzis
Chourmouzios A
CA
Saia
Francesco
F
Tanabe
Kengo
K
Degertekin
Muzaffer
M
Hofma
Sjoerd
S
McFadden
Eugene
E
Sianos
Georgios
G
Smits
Pieter C
PC
van der Giessen
Willem J
WJ
de Feyter
Pim
P
van Domburg
Ron T
RT
Serruys
Patrick W
PW
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D020099:Coated Materials, Biocompatible / Q000627:therapeutic use*; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000453:epidemiology / Q000517:prevention & control*; D023921:Coronary Stenosis / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D020123:Sirolimus / Q000627:therapeutic use*; D015607:Stents; D016896:Treatment Outcome
D020099:Coated Materials, Biocompatible; D007166:Immunosuppressive Agents; D020123:Sirolimus