title: Long-term clinical outcomes of real-world experience using sirolimus-eluting stents in saphenous vein graft disease.
abstract: OBJECTIVE
  To evaluate the long-term clinical outcomes of patients undergoing percutaneous coronary intervention for saphenous vein graft (SVG) disease. Specifically, we compared clinical endpoints of patients who received sirolimus-eluting stents (SES) versus bare-metal stents (BMS) for SVG disease.
  
  
  BACKGROUND
  A recent small randomized-controlled trial (RCT) reported increased mortality with the use of SES in SVG disease.
  
  
  METHODS
  We retrospectively identified patients who underwent SES placement for a SVG lesion(s) at our institutions over a 4-year period. The procedural and medical records were reviewed to identify predetermined clinical outcomes.
  
  
  RESULTS
  318 patients who underwent SES placement for a SVG lesion were identified. 7 patients were lost to follow-up. 141/311 patients (45%) received SES, while 170/311 (55%) received BMS. At a mean follow-up of 34 months, there was a reduction in target lesion revascularization (TLR) (7% vs. 14%, P = 0.07) without an increased risk of mortality (6% vs. 12%, P = 0.06) in patients who received SES compared to patients who received BMS. When compared to the recent RCT's SES patients at long-term follow-up, our SES patients had significantly less mortality; rates of myocardial infarction, TLR, target vessel revascularization, and major adverse cardiac events; and were more likely to be taking dual antiplatelet and statin medications.
  
  
  CONCLUSIONS
  Our results support that SES used in SVG lesions result in a reduction in TLR without an increased risk of mortality, and therefore may be an equally safe and feasible technique for revascularization with excellent long-term clinical outcomes. These patients may benefit from prolonged dual antiplatelet and statin medication regimens.
authors.affiliation: Division of Cardiology, Loyola University Medical Center, Maywood, Illinois, USA.
authors.forename: Ravi K
authors.initials: RK
authors.lastname: Ramana
authors.forename: Adam
authors.initials: A
authors.lastname: Ronan
authors.forename: Kevin
authors.initials: K
authors.lastname: Cohoon
authors.forename: David
authors.initials: D
authors.lastname: Homan
authors.forename: Jessica
authors.initials: J
authors.lastname: Sutherland
authors.forename: Lowell
authors.initials: L
authors.lastname: Steen
authors.forename: Jayson
authors.initials: J
authors.lastname: Liu
authors.forename: Henry
authors.initials: H
authors.lastname: Loeb
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Lewis
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D023903:Coronary Restenosis / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008297:Male; D008670:Metals; D018579:Patient Selection; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011474:Prosthesis Design; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012501:Saphenous Vein / Q000637:transplantation*; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008670:Metals; D010975:Platelet Aggregation Inhibitors; D020123:Sirolimus