Key result
DES shows no long-term benefit over BMS for mortality or stent failure in SVGs.
Why the study?
Does percutaneous coronary intervention with drug-eluting stents improve all-cause mortality and stent failure in patients with saphenous vein graft lesions compared to bare-metal stents?
Cohort (n=529)
Does percutaneous coronary intervention with drug-eluting stents improve all-cause mortality and stent failure in patients with saphenous vein graft lesions compared to bare-metal stents?
Absolute Event Rate: 18.8% vs 21.8%
p-value: p=0.64
In patients undergoing PCI for saphenous vein graft lesions, the use of drug-eluting stents did not significantly reduce long-term all-cause mortality or stent failure compared to bare-metal stents.
DES confer no long-term survival benefit versus BMS in SVG lesions; leaves open optimal stent selection pending prospective trials.
OBJECTIVES: We used the Western Denmark Heart Registry to assess one-year and long-term all-cause mortality and stent failure following Percutaneous Coronary Intervention (PCI) with drug-eluting stents (DES) or bare-metal stents (BMS). BACKGROUND: The use of DES compared with BMS during PCI has reduced the risk of restenosis in native coronary artery lesions. In saphenous vein grafts (SVG) the outcome after DES compared with BMS is insufficiently described. METHODS: From January 1, 2002 to December 31, 2010 all patients with PCI of SVG lesions were identified among 3.0 million inhabitants. Stent failure was defined as clinically driven target lesion revascularization, graft occlusion without intervention, or stent thrombosis. RESULTS: The study cohort consisted of 529 patients with 755 SVG lesions (348 DES patients with 510 lesions and 181 BMS patients with 245 lesions). Mean age did not differ between patients with DES-treated lesions compared to patients with BMS-treated lesions (67.5 ± 9.1 years vs. 67.6 ± 9.3 years; P = 0.85). The median follow-up time was 3.0 years (25th-75th percentile: 1.4-5.1 years). One-year (n = 27 (8.2%) vs. n = 12 (6.7%), log rank P = 0.60) and 3-year cumulative mortality (n = 31 (18.8%) vs. n = 59 (21.8%), log rank P = 0.64) did not differ significantly between DES- and BMS-treated patients. One-year cumulative stent failure was seen in 39 (6.6%) DES-treated lesions vs. 24 (10.8%) BMS-treated lesions (P = 0.088), and 3-year cumulative stent failure in 48 (15.4%) vs. 34 (18.8%) lesions (P = 0.25), respectively. CONCLUSION: In SVG lesions, DES showed no long-term benefit compared to BMS in rates of all-cause mortality or stent failure.
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Hougaard et al. (2013) conducted a cohort in Saphenous vein graft (SVG) lesions (n=529). Drug-eluting stents (DES) vs. Bare-metal stents (BMS) was evaluated on 3-year cumulative all-cause mortality (p=0.64). In saphenous vein graft lesions, drug-eluting stents showed no long-term benefit over bare-metal stents for 3-year all-cause mortality (18.8% vs 21.8%; P=0.64) or stent failure.
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