Implantation of sirolimus-eluting stents in saphenous vein grafts is associated with high clinical follow-up event rates compared with treatment of native vessels.
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.
Hoffmann
Rainer
R
aMedical Clinic I, University RWTH Aachen, Aachen, Germany. RHoffmann@UKAACHEN.de
Hamm
Christian
C
Nienaber
Christoph A
CA
Levenson
Benny
B
Bonzel
Tassilo
T
Sabin
Georg
G
Senges
Jochen
J
Zahn
Ralf
R
Tebbe
Ulrich
U
Pfannebecker
Thomas
T
Richardt
Hans Gert
HG
Schneider
Steffen
S
Kelm
Malte
M
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
D007166:Immunosuppressive Agents; D020123:Sirolimus