title: Drug-eluting stents appear superior to bare metal stents for vein-graft PCI in vessels up to a stent diameter of 4 mm.
abstract: BACKGROUND
  Research trials have shown improved short-term outcome with drug-eluting stents (DES) over bare metal stents (BMS) in saphenous vein graft (SVG) percutaneous coronary intervention (PCI), primarily by reducing target vessel revascularization (TVR) for in-stent restenosis. We compared the outcomes in patients undergoing SVG stent implantation treated with DES or BMS. In exploratory analyses we investigated the influence of stent generation and diameter.
  
  
  METHODS
  Data were obtained from a prospective database of 657 patients who underwent PCI for SVG lesions between 2003 and 2011. A total of 344 patients had PCI with BMS and 313 with DES. Propensity scores were developed based on 15 observed baseline covariates in a logistic regression model with stent type as the dependent variable. The nearest-neighbour-matching algorithm with Greedy 5-1 Digit Matching was used to produce two patient cohorts of 313 patients each. We assessed major adverse cardiac events (MACE) out to a median of 3.3 years (interquartile range: 2.1-4.1). MACE was defined as all-cause mortality, myocardial infarction (MI), TVR and stroke.
  
  
  RESULTS
  There was a significant difference in MACE between the two groups in favour of DES (17.9% DES vs. 31.2% BMS group; p = 0.0017) over the 5-year follow-up period. MACE was driven by increased TVR in the BMS group. There was no difference in death, MI or stroke. Adjusted Cox analysis confirmed a decreased risk of MACE for DES compared with BMS 0.75 (95% confidence interval (CI) 0.52-0.94), with no difference in the hazard of all-cause mortality (hazard ratio: 1.08; 95% CI: 0.77-1.68). However, when looking at stent diameters greater than 4 mm, no difference was seen in MACE rates between BMS and DES.
  
  
  CONCLUSIONS
  Overall in our cohort of patients who had PCI for SVG disease, DES use resulted in lower MACE rates compared with BMS over a 5-year follow-up period; however, for stent diameters over 4 mm no difference in MACE rates was seen.
authors.affiliation: Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London - UK.
authors.forename: Oliver P
authors.initials: OP
authors.lastname: Guttmann
authors.affiliation: Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London - UK; Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London - UK; NIHR Cardiovascular Biomedical Research Unit, Barts Heart Centre, Barts Health NHS Trust, London - UK.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Jones
authors.affiliation: Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London - UK.
authors.forename: Kassem A
authors.initials: KA
authors.lastname: Safwan
authors.affiliation: Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London - UK.
authors.forename: Sean
authors.initials: S
authors.lastname: Gallagher
authors.affiliation: Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London - UK; Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London - UK; NIHR Cardiovascular Biomedical Research Unit, Barts Heart Centre, Barts Health NHS Trust, London - UK.
authors.forename: Krishnaraj S
authors.initials: KS
authors.lastname: Rathod
authors.affiliation: Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London - UK; Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London - UK; NIHR Cardiovascular Biomedical Research Unit, Barts Heart Centre, Barts Health NHS Trust, London - UK.
authors.forename: Steve
authors.initials: S
authors.lastname: Hamshere
authors.affiliation: Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London - UK.
authors.forename: Elliot J
authors.initials: EJ
authors.lastname: Smith
authors.affiliation: Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London - UK; Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London - UK; NIHR Cardiovascular Biomedical Research Unit, Barts Heart Centre, Barts Health NHS Trust, London - UK.
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Jain
authors.affiliation: Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London - UK; Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London - UK; NIHR Cardiovascular Biomedical Research Unit, Barts Heart Centre, Barts Health NHS Trust, London - UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Mathur
authors.affiliation: Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London - UK; NIHR Cardiovascular Biomedical Research Unit, Barts Heart Centre, Barts Health NHS Trust, London - UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Wragg
authors.affiliation: Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London - UK; NIHR Cardiovascular Biomedical Research Unit, Barts Heart Centre, Barts Health NHS Trust, London - UK.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Knight
authors.affiliation: Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London - UK; NIHR Cardiovascular Biomedical Research Unit, Barts Heart Centre, Barts Health NHS Trust, London - UK.
authors.forename: Roshan
authors.initials: R
authors.lastname: Weerackody
keywords: Bare metal stent; Drug-eluting stent; Percutaneous intervention; Stroke; Target vessel revascularisation; Venous graft