title: Long-term outcomes with first- vs. second-generation drug-eluting stents in saphenous vein graft lesions.
abstract: BACKGROUND
  As compared with bare metal stents, first-generation drug-eluting stents (DES) improved post-procedural outcomes in aortocoronary saphenous vein graft (SVG) lesions, but there is limited information on outcomes after use of second-generation DES in SVGs.
  
  
  METHODS
  We compared the outcomes of patients who received first- (n = 81) with those who received second-generation (n = 166) DES in SVG lesions at our institution between 2006 and 2013. Major adverse cardiac events (MACE) were defined as the composite of all-cause death, myocardial infarction, and target vessel revascularization.
  
  
  RESULTS
  Mean age was 66.0 ± 8.1 years and 97.6% of the patients were men. Mean SVG age was 11.1 ± 0.4 years. First-generation DES were sirolimus-eluting (n = 17) and paclitaxel-eluting (n = 64) stents. Second-generation DES were everolimus-eluting (n = 115) and zotarolimus-eluting (n = 51) stents. Median follow-up was 41 months. At 2-years post-procedure, patients with first- and second-generation DES had similar rates of death (20.91% vs. 20.27%, P = 0.916), target lesion revascularization (16.39% vs. 20.00%, P = 0.572), target vessel revascularization (20.97% vs. 23.16%, P = 0.747), myocardial infarction (26.15% vs. 23.00%, P = 0.644), and MACE (43.5% vs. 40.87%, P = 0.707), respectively.
  
  
  CONCLUSIONS
  Outcomes with first- and second-generation DES in SVGs are similar. Novel stent designs are needed to further improve the clinical outcomes in this challenging patient and lesion subgroup. © 2015 Wiley Periodicals, Inc.
authors.affiliation: Department of Cardiovascular Diseases, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Nagendra R
authors.initials: NR
authors.lastname: Pokala
authors.affiliation: Department of Cardiovascular Diseases, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Rohan V
authors.initials: RV
authors.lastname: Menon
authors.affiliation: Department of Cardiovascular Diseases, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Siddharth M
authors.initials: SM
authors.lastname: Patel
authors.affiliation: Department of Cardiovascular Diseases, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas.
authors.forename: George
authors.initials: G
authors.lastname: Christopoulos
authors.affiliation: Department of Cardiovascular Diseases, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Georgios E
authors.initials: GE
authors.lastname: Christakopoulos
authors.affiliation: Department of Cardiovascular Diseases, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Anna P
authors.initials: AP
authors.lastname: Kotsia
authors.affiliation: Department of Cardiovascular Diseases, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Bavana V
authors.initials: BV
authors.lastname: Rangan
authors.affiliation: Department of Cardiovascular Diseases, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Michele
authors.initials: M
authors.lastname: Roesle
authors.affiliation: Department of Cardiovascular Diseases, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Shuaib
authors.initials: S
authors.lastname: Abdullah
authors.affiliation: Department of Cardiovascular Diseases, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Jerrold
authors.initials: J
authors.lastname: Grodin
authors.affiliation: Department of Cardiovascular Diseases, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Dharam J
authors.initials: DJ
authors.lastname: Kumbhani
authors.affiliation: Department of Cardiovascular Diseases, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hastings
authors.affiliation: Department of Cardiovascular Diseases, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: Department of Cardiovascular Diseases, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas.
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D006801:Humans; D015994:Incidence; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000637:transplantation*; D015996:Survival Rate / Q000639:trends; D013781:Texas / Q000453:epidemiology
keywords: drug eluting; percutaneous coronary intervention; saphenous vein bypass graft; saphenous vein graft interventions; stent