title: Seven-year safety and efficacy of the unrestricted use of drug-eluting stents in saphenous vein bypass grafts.
abstract: OBJECTIVE
  The aim was to investigate the 7-year clinical outcomes of patients treated with either drug-eluting stents (DES) or bare-metal stents (BMS) for saphenous vein graft disease (SVG).
  
  
  BACKGROUND
  Atherosclerotic disease in SVG has several peculiarities which make it difficult to extrapolate outcomes of the use of DES as compared to BMS, from outcomes observed in native coronary arteries. To date no long-term safety and efficacy results for DES in SVG have been published.
  
  
  METHODS
  Between January, 2000 and December, 2005 a total of 250 consecutive patients with saphenous vein graft disease were sequentially treated with DES (either sirolimus- or paclitaxel-eluting stents) or with BMS. Yearly follow-up was performed.
  
  
  RESULTS
  At 87 months (7.25 years), a total of 101 patients died (58 [46%] in the BMS group and 43 [42%] in the DES group, P-value= 0.4). There was no significant difference in the combined endpoint mortality or myocardial infarction. Cumulative target vessel revascularisation (TVR) was higher in the BMS group compared to the DES group (41% vs. 29%, respectively; adjusted hazard ratio [HR] 0.63, 95% confidence interval [CI]: 0.39-1.0). The cumulative incidence of major adverse cardiac events was 73% vs. 68% in the BMS and DES groups, respectively (adjusted HR 0.93, 95% CI: 0.67-1.3).
  
  
  CONCLUSIONS
  In the present study, the unrestricted use of DES for SVG lesions appeared safe and effective up to 7.25 years- and the use of DES resulted in a clinically relevant lower rate of TVR.
authors.affiliation: Thoraxcenter, Erasmus Medical Center, Ba-559 Dr. Molewaterplein 40, 3015GD Rotterdam, the Netherlands.
authors.forename: Sjoerd T
authors.initials: ST
authors.lastname: Nauta
authors.forename: Nicolas M
authors.initials: NM
authors.lastname: Van Mieghem
authors.forename: Michael
authors.initials: M
authors.lastname: Magro
authors.forename: Jaap W
authors.initials: JW
authors.lastname: Deckers
authors.forename: Cihan
authors.initials: C
authors.lastname: Simsek
authors.forename: Robert Jan
authors.initials: RJ
authors.lastname: Van Geuns
authors.forename: Wim J
authors.initials: WJ
authors.lastname: Van Der Giessen
authors.forename: Peter
authors.initials: P
authors.lastname: De Jaegere
authors.forename: Evelyn
authors.initials: E
authors.lastname: Regar
authors.forename: Ron T
authors.initials: RT
authors.lastname: Van Domburg
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D002317:Cardiovascular Agents / Q000008:administration & dosage; D016009:Chi-Square Distribution; D003251:Constriction, Pathologic; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D054855:Drug-Eluting Stents; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008670:Metals; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D009426:Netherlands; D017239:Paclitaxel / Q000008:administration & dosage; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000637:transplantation*; D020123:Sirolimus / Q000008:administration & dosage; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D008670:Metals; D017239:Paclitaxel; D020123:Sirolimus