Comparison of the long-term safety and efficacy of drug-eluting and bare-metal stent implantation in saphenous vein grafts.
BACKGROUND
Concerns about the long-term safety of drug-eluting stents (DES) in saphenous vein grafts has become an area of controversy and uncertainty.


RESULTS
In this retrospective registry, we compared the outcomes in 127 patients (143 lesions) treated with DES from April 2002 to June 2006 (DES group) with 131 patients (160 lesions) treated with bare-metal stents in the preceding 36 months (bare-metal stent group). End points analyzed were cumulative death, myocardial infarction, and target vessel revascularization at 2 years after stent implantation. The DES group was significantly (P<0.05) more complex with a greater frequency of diabetes (33.1%versus 15.3%), older grafts (11.6+/-5.3 years versus 9.6+/-5.2 years), restenotic lesions (23.8% versus 4.4%), total occlusions (7.7% versus 1.2%), and smaller grafts (3.16+/-0.66 mm versus 3.44+/-0.76 mm) treated with longer stents (34.1+/-25.1 mm versus 22.7+/-11.6 mm). At 2 years, there was no statistical difference in death (8.7% versus 7.8%), myocardial infarction (6.3% versus 9.4%), or target vessel revascularization (19.7% versus 24.2%) between DES and bare-metal stents, respectively. A propensity analysis to adjust for baseline differences suggested that there was no observed association between DES and increased mortality (hazard ratio, 0.72; 95% CI, 0.21 to 2.44; P=0.60) but possibly an association with a reduction in target vessel revascularization (hazard ratio, 0.31; 95% CI, 0.14 to 0.66; P=0.002).


CONCLUSIONS
Despite being implanted in patients and lesions more complex than the bare-metal stent group, there was no observed association between DES implantation in saphenous vein grafts and an increase in late mortality. DES may maintain their efficacy in reducing revascularization rates in diseased saphenous vein grafts over a 2-year follow-up period.
Latib
Azeem
A
Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
Ferri
Luca
L
Ielasi
Alfonso
A
Cosgrave
John
J
Godino
Cosmo
C
Bonizzoni
Erminio
E
Romagnoli
Enrico
E
Chieffo
Alaide
A
Valgimigli
Marco
M
Penzo
Carlo
C
Carlino
Mauro
M
Michev
Iassen
I
Sangiorgi
Giuseppe M
GM
Montorfano
Matteo
M
Airoldi
Flavio
F
Colombo
Antonio
A
D000368:Aged; D003251:Constriction, Pathologic / Q000209:etiology / Q000517:prevention & control; D054855:Drug-Eluting Stents / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications; D019919:Prosthesis Implantation / Q000295:instrumentation* / Q000401:mortality / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D019737:Transplants