title: Real-world experience of drug-eluting stents in saphenous vein grafts compared to native coronary arteries: results from the prospective multicenter German DES.DE registry.
abstract: BACKGROUND
  Bypass-graft intervention was associated with worse outcomes in the bare-metal stent era. Without sufficiently powered data from subgroup analyses, and in absence of randomized controlled trials targeting clinical endpoints, controversy is ongoing over safety and efficacy of drug-eluting stents (DES) in saphenous vein graft (SVG) lesions.
  
  
  RESULTS
  Between October 2005 and October 2006, 5,183 patients receiving DES in SVG (n = 251) or native coronary arteries (NCA) (n = 4,932) were enrolled at 98 DES.DE sites. The composite of death, myocardial infarction (MI), and stroke defined as major adverse cardiac and cerebrovascular events (MACCE) and target-vessel revascularization (TVR) were defined as primary endpoints. Baseline clinical and descriptive morphology of coronary artery disease revealed more severe lesions and comorbidities in the SVG group. At 1-year follow-up, the SVG group suffered from higher rates of overall death (6.6 vs. 2.5%; p < 0.0001), myocardial infarction (5.9 vs. 2.2%; p < 0.0001), MACCE (13.6 vs. 5.4%; p < 0.0001), TVR (17.7 vs. 10.4%; p < 0.001) and overall stent thrombosis (10.0 vs. 3.7%; p < 0.0001).
  
  
  CONCLUSIONS
  Data collected in DES.DE revealed that first generation DES used in SVG lesions did not offset the worse clinical outcomes of bypass-graft intervention. Such sobering results in SVG may suggest to opt for native vessel PCI preferentially or occasionally for surgical reintervention as decided by the Heart Team.
authors.affiliation: Division of Cardiology, Department of Internal Medicine I, Heart Center Rostock, University Hospital Rostock, Rostock School of Medicine, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Akin
authors.forename: Marcus
authors.initials: M
authors.lastname: Wiemer
authors.forename: Steffen
authors.initials: S
authors.lastname: Schneider
authors.forename: Jochen
authors.initials: J
authors.lastname: Senges
authors.forename: Matthias
authors.initials: M
authors.lastname: Hochadel
authors.forename: Gert
authors.initials: G
authors.lastname: Richardt
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdel-Wahab
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Nienaber
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000628:therapy*; D054855:Drug-Eluting Stents / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D009204:Myocardial Revascularization / Q000379:methods; D011446:Prospective Studies; D012042:Registries; D012501:Saphenous Vein / Q000637:transplantation*; D020521:Stroke / Q000453:epidemiology; D013927:Thrombosis / Q000209:etiology; D016896:Treatment Outcome
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