title: Implantation of sirolimus-eluting stents in saphenous vein grafts is associated with high clinical follow-up event rates compared with treatment of native vessels.
abstract: OBJECTIVE
  The clinical effectiveness of sirolimus-eluting stents (SES) for treatment of patients with saphenous vein graft disease is not well defined. This analysis sought to evaluate the clinical follow-up after treatment of stenotic saphenous vein grafts using SES in a large patient registry. Patients treated with SES for saphenous vein graft disease were compared with patients receiving SES in native vessel disease.
  
  
  METHODS
  This is a subanalysis from the prospective multicenter German Cypher Stent Registry. Only patients with completed 6 months clinical follow-up were included. The analysis comprises 344 patients with 353 lesions in saphenous vein grafts treated with 400 SES (Cypher, Cordis Inc., Cordis Corp., Warren, New Jersey, USA) and 6411 patients with 7607 native coronary artery lesions treated with 8725 SES.
  
  
  RESULTS
  Mean SES length per lesion was 22.6+/-11.7 mm and mean stent diameter 3.0+/-0.3 mm in saphenous vein graft lesions. Target vessel revascularization rate was 18.1% and major adverse cardiovascular events (MACE) rate was 23.8% at 6-month follow-up after SES implantation for saphenous vein graft lesions. Even after adjustment for different baseline characteristics, target vessel failure and MACE rate were significantly higher after SES implantation for saphenous vein graft lesions than for native coronary vessel stenosis [odds ratio: 2.10 (95% confidence interval: 1.40-3.13), P<0.001] and [odds ratio: 2.15 (95% confidence interval: 1.49-3.09), P<0.001], respectively.
  
  
  CONCLUSIONS
  Treatment of saphenous vein graft disease is associated with high target vessel revascularization and MACE rates also with the use of SES if applied to unselected patients. Target vessel revascularization and MACE rates remain significantly higher after SES for saphenous vein graft lesions than after SES in native vessel disease.
authors.affiliation: aMedical Clinic I, University RWTH Aachen, Aachen, Germany. RHoffmann@UKAACHEN.de
authors.forename: Rainer
authors.initials: R
authors.lastname: Hoffmann
authors.forename: Christian
authors.initials: C
authors.lastname: Hamm
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Nienaber
authors.forename: Benny
authors.initials: B
authors.lastname: Levenson
authors.forename: Tassilo
authors.initials: T
authors.lastname: Bonzel
authors.forename: Georg
authors.initials: G
authors.lastname: Sabin
authors.forename: Jochen
authors.initials: J
authors.lastname: Senges
authors.forename: Ralf
authors.initials: R
authors.lastname: Zahn
authors.forename: Ulrich
authors.initials: U
authors.lastname: Tebbe
authors.forename: Thomas
authors.initials: T
authors.lastname: Pfannebecker
authors.forename: Hans Gert
authors.initials: HG
authors.lastname: Richardt
authors.forename: Steffen
authors.initials: S
authors.lastname: Schneider
authors.forename: Malte
authors.initials: M
authors.lastname: Kelm
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology / Q000628:therapy; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000628:therapy; D018572:Disease-Free Survival; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011446:Prospective Studies; D012042:Registries; D012501:Saphenous Vein / Q000473:pathology*; D020123:Sirolimus / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus