title: Comparison of long-term outcomes of drug-eluting stents and bare metal stents for saphenous vein graft stenosis.
abstract: OBJECTIVE
  Our aim was to compare the long-term outcomes between drug-eluting stents and bare-metal stents for saphenous vein graft stenosis.
  
  
  BACKGROUND
  The ideal type of stent to treat saphenous vein graft stenosis has not been clearly established. Short-term randomized controlled trial results comparing drug-eluting stents with bare-metal stents for saphenous vein graft stenosis are conflicting, intermediate-term retrospective studies and meta-analyses at two years suggest no difference in outcomes, and there are no long term follow-up studies. The need for long term follow-up data has become emerged with concern over late stent thrombosis.
  
  
  METHODS
  246 saphenous vein graft patients undergoing stenting from August 2002-December 2008 were studied. Overall survival and event-free survival were compared by Kaplan-Meier method. Hazard ratios (HR) were calculated by Cox-proportional hazards models.
  
  
  RESULTS
  We treated 133 patients with DES (median follow-up four years) and 113 patients with BMS (median follow-up four years) for SVG stenosis. Overall survival (77.0% ± 3.9% vs. 70.6% ± 4.6%, log-rank P = 0.60) and MACE-free survival (57.5% ± 4.6% vs. 56.8% ± 4.9, log-rank P = 0.70) were not significantly different between the DES and BMS groups. Although BMS was associated with increased risk of target lesion revascularization (TLR) (freedom from TLR 85.2% ± 3.5% vs. 90.0% ± 3.0%, HR 2.07, 95% CI 0.97-4.42, log-rank P = 0.05), there was no significant difference in the freedom from myocardial infarction (86.7% ± 3.3% vs. 88.7% ± 3.2%, log-rank P = 0.39) or target vessel revascularization (77.1% ± 4.2% vs. 76.1% ± 4.2%, log-rank P = 0.33) between the two groups.
  
  
  CONCLUSIONS
  Although mortality is not statistically different between DES and BMS for SVG stenosis, BMS is associated with increased risk of revascularization, thus suggesting the superiority of DES over BMS in the long term.
authors.affiliation: Cedars-Sinai Heart Institute, Cedars Sinai Medical Center, Los Angeles, California 90048, USA.
authors.forename: Tarun
authors.initials: T
authors.lastname: Chakravarty
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Morrissey
authors.forename: Brett
authors.initials: B
authors.lastname: Wertman
authors.forename: Jesse
authors.initials: J
authors.lastname: Naghi
authors.forename: Stanley
authors.initials: S
authors.lastname: Chou
authors.forename: Pavel
authors.initials: P
authors.lastname: Goykhman
authors.forename: Niraj
authors.initials: N
authors.lastname: Doctor
authors.forename: James
authors.initials: J
authors.lastname: Mirocha
authors.forename: James S
authors.initials: JS
authors.lastname: Forrester
authors.forename: Raj
authors.initials: R
authors.lastname: Makkar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D003251:Constriction, Pathologic; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D018572:Disease-Free Survival; 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; D015141:Los Angeles; D008297:Male; D008670:Metals; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000637:transplantation*; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D008670:Metals