Lack of clinical long-term benefit with the use of a drug eluting stent compared to use of a bare metal stent in saphenous vein grafts.
BACKGROUND
Small randomized trials have shown short-term improved outcome with drug-eluting stents (DES) over bare metal stent (BMS) in saphenous vein graft (SVG) interventions by reducing in-stent restenosis and target vessel revascularization (TVR). It is not clear, however, if these benefits are maintained long term. The aim of this study is to compare the outcome in a larger cohort of patients undergoing SVG stent implantation with DES or BMS, at 2 years.


METHODS
From among 250 patients who underwent SVG stenting, 225 patients with available follow-up were selected from data bases at the three participating institutions. One-hundred-six patients had DES (sirolimus, paclitaxel or tacrolimus eluting stent) and 119 patients had any available BMS from April 2002 to December 2006. The primary endpoint was MACE rate, a combination of cardiac death, S-T elevation myocardial infarction (STEMI) and target lesion revascularization. Secondary end points were the individual components of the primary endpoint. Follow-up was obtained by mailed interviews or telephone calls and review of the hospital chart.


RESULTS
The DES and BMS groups had similar age (71 +/- 8 years vs. 70 +/- 7 years, P = 1.0), diabetes (45% vs. 36%, P = 0.3), history of MI (58% vs. 51%, P = 0.6), EF (44% vs. 47%, P = 0.2) and previous PCI (40% vs. 35%, P = 0.4). Reference vessel diameter (3.15 +/- 0.5 mm vs. 3.5 +/- 0.5 mm. P = 0.001) and stent size (3.3 +/- 0.4 mm vs. 3.9 +/- 0.5 mm, P = 0.001) were smaller in the DES group; however, the BMS were longer (24 +/- 10 mm vs. 21 +/- 6 mm, P = 0.05). At one year there was a trend (P = 0.1) for lower MACE rate in the DES group, but at two years there was no difference in MACE free survival between the DES and BMS groups (81 % vs. 82%, P = 0.9). The death rate was similar (6% each) with three patients having STEMI (two in the DES and one in the BMS). TVR was also similar (14% in each group).


CONCLUSIONS
In patients undergoing treatment of SVG disease with a stent, the marginal benefit of DES seen at 1 year was lost at 2-year follow-up.
Gioia
Giuseppe
G
giuseppe.gioia@atlanticare.org
Benassi
Alberto
A
Mohendra
Raghar
R
Chowdhury
Khaza
K
Masood
Iqbal
I
Matthai
William
W
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D054855:Drug-Eluting Stents; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation*; D013997:Time Factors; D016896:Treatment Outcome; D050257:Tubulin Modulators / Q000008:administration & dosage
D007166:Immunosuppressive Agents; D050257:Tubulin Modulators