title: Early beneficial effects of drug-eluting stents in vein grafts wane during long term follow-up: a case-control study.
abstract: OBJECTIVE
  The aim of the study was to compare outcomes of drug-eluting stents (DES) versus bare-metal stents (BMS) in saphenous vein graft (SVG) interventions in a case-control study with a long-term follow-up.
  
  
  BACKGROUND
  Safety and efficacy of DES in SVG interventions are still controversial.
  
  
  METHODS
  We performed a multicenter registry assessing clinical outcomes with DES vs. BMS. We included 311 patients (239 men, age 68 ± 8 years) who underwent percutaneous coronary interventions (PCI) of SVG lesions with DES (n = 138) or BMS (n = 173) with a 2-year follow-up.
  
  
  RESULTS
  The two groups were similar for age, sex, main risk factors, incidence of diabetes, use of IIb/IIIa antagonists, use of aspiration devices or filters, number of stents, and total stent length. Overall, at 9 months follow-up incidence of major adverse cardiac events (MACE) and target vessel revascularization (TVR) were significantly lower in the DES group compared with the BMS group (10.9% vs. 22.0%, P = 0.014 and 8.7% vs. 19.1% in DES and BMS respectively, P = 0.015), while there was no significant difference in incidence of myocardial infarction (5.1% vs. 5.2%, P = 0.96) or death (2.2% vs. 4%, respectively, P = 0.54). However, at 24-month follow-up incidence of MACE was 29.7% in the DES group and 37.0% in BMS group (P = 0.29); incidence of TVR (23.2% vs. 28.9% P = 0.39), myocardial infarction (9.4% vs. 9.2%), death (7.2% vs. 6.9%) were also similar in the two groups.
  
  
  CONCLUSIONS
  Although DES appear safe, our findings suggest that the early benefit of DES in SVG may rapidly wane during long-term follow-up.
authors.affiliation: Emodinamica, Ospedale San Filippo Neri, Rome, Italy. vpasceri@hotmail.com
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Pasceri
authors.forename: Giandomenico
authors.initials: G
authors.lastname: Tarsia
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Niccoli
authors.forename: Nicola
authors.initials: N
authors.lastname: Viceconte
authors.forename: Italo
authors.initials: I
authors.lastname: Porto
authors.forename: Antonio Maria
authors.initials: AM
authors.lastname: Leone
authors.forename: Carlo
authors.initials: C
authors.lastname: Trani
authors.forename: Giulio
authors.initials: G
authors.lastname: Speciale
authors.forename: Pasquale
authors.initials: P
authors.lastname: Lisanti
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D018572:Disease-Free Survival; D054855:Drug-Eluting Stents; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D057216:Propensity Score; D011446:Prospective Studies; D011474:Prosthesis Design; D012042:Registries; D012307:Risk Factors; D012501:Saphenous Vein / Q000637:transplantation*; D013997:Time Factors; D016896:Treatment Outcome