title: Comparison of first- and second-generation drug-eluting stents in saphenous vein grafts used as aorto-coronary conduits.
abstract: Saphenous vein grafts (SVGs) are prone to an aggressive atherosclerotic process, and the efficacy of drug-eluting stents (DES) in treating this is still debated. In recent years, second-generation DES have been increasingly used in SVG intervention. The main objective of this study was to compare midterm clinical outcomes between first- and second-generation DES in SVGs because data regarding the use of second-generation DES in SVG are lacking. Patients treated with first-generation DES (127 patients with 143 lesions) and those treated with second-generation DES (84 patients with 100 lesions) were included in the study. Major adverse cardiac events, defined as the composite of all-cause death, myocardial infarction, and target vessel revascularization, as well as target vessel revascularization and target lesion revascularization separately, were evaluated at 30-day, 12-month, and 18-month follow-up. Baseline characteristics were similar between the 2 groups. Older grafts were treated with second-generation DES (11.6 ± 5.3 vs 14.3 ± 6.0 years, p = 0.001). Stent length was longer in the first-generation group (34.1 ± 25.1 vs 30.5 ± 19.4 mm, p = 0.006), and maximum balloon diameter was smaller in the second-generation group (3.42 ± 0.42 vs 3.30 ± 0.41 mm, p = 0.003). Embolic protection device use was higher in the second-generation DES group (55.2% vs 72.0%, p = 0.012). At 18-month follow-up, rates of major adverse cardiac events, target vessel revascularization, and target lesion revascularization for the first- and second-generation groups were 24.4% versus 20.2% (p = 0.479), 18.1% versus 14.2% (p = 0.465), and 15.0% versus 10.7% (p = 0.373), respectively. In conclusion, second-generation DES are at least comparable with first-generation DES with regard to clinical outcomes at midterm follow-up.
authors: Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
authors: Charis
authors: C
authors: Costopoulos
authors: Azeem
authors: A
authors: Latib
authors: Toru
authors: T
authors: Naganuma
authors: Alessandro
authors: A
authors: Sticchi
authors: Alaide
authors: A
authors: Chieffo
authors: Filippo
authors: F
authors: Figini
authors: Mauro
authors: M
authors: Carlino
authors: Matteo
authors: M
authors: Montorfano
authors: Charbel
authors: C
authors: Naim
authors: Masanori
authors: M
authors: Kawaguchi
authors: Francesco
authors: F
authors: Giannini
authors: Antonio
authors: A
authors: Colombo
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents; D002423:Cause of Death; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D023903:Coronary Restenosis / Q000401:mortality / Q000517:prevention & control* / Q000601:surgery; D054855:Drug-Eluting Stents; D000068338:Everolimus; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control* / Q000601:surgery; D011474:Prosthesis Design; D012086:Reoperation; D020123:Sirolimus / Q000031:analogs & derivatives*; D014680:Veins / Q000637:transplantation*
chemical_list: D000970:Antineoplastic Agents; D000068338:Everolimus; C489443:zotarolimus; D017239:Paclitaxel; D020123:Sirolimus