Drug-Eluting Stents Compared with Bare Metal Stents Improve Late Outcome after Saphenous Vein Graft but Not after Large Native Vessel Interventions

Abstract

Objectives: To define long-term efficacy of different stent types in saphenous vein graft (SVG) interventions. Methods: In BASKET (Basel Stent Cost Effectiveness Trial), major adverse cardiac events (MACE), i.e. cardiac death, myocardial infarction and symptom-driven target vessel revascularization (TVR) were assessed after 18 months comparing drug-eluting stents (DES) versus bare metal stents (BMS), and SVG and large native vessels (≧3.0 mm). Results: Large vessel interventions were performed in 605 patients. Patients with SVG interventions (n = 47, 8%) were older and had more often hypertension, prior myocardial infarction, prior revascularization and multivessel disease and less frequent ST-elevation myocardial infarction than patients with large native vessel interventions (n = 558, 92%). Stent number and length were higher in SVG than in large native vessel interventions. Baseline characteristics were similar for DES and BMS. In SVG stenting, long-term outcome was better in DES- than in BMS-treated patients (MACE 21 vs. 62%, p = 0.007, mainly due to TVR 18 vs. 46%, p = 0.045), but for large native vessel stenting, no significant difference was noted (MACE: 13 vs. 16%, p = 0.40). Conclusions: Among patients with SVG disease, treatment with DES resulted in a better long-term outcome than treatment with BMS. In contrast, no DES benefit was found in similarly sized native vessels regarding MACE.

Safety and efficacy of drug eluting stents compared with bare metal stents for saphenous vein graft interventions: A comprehensive meta‐analysis of randomized trials and observational studies comprising 7,994 patients

“…There were two randomized trials [10,11], one subgroup analysis from a randomized trial [12] and 26 observational studies comparing DES with BMS for SVG lesions that met selection criteria for our metaanalysis. A total of 7,994 patients were included in this meta-analysis with 4,187 patients in the DES arm and 3,807 patients in the BMS group (Fig.…”

“…Randomized controlled trials (RCTs) have yielded divergent results in terms of the safety and efficacy of DES vs. BMS for PCI of SVG lesions [10,12]. Infact, results from the DELAYED RRISC trial demonstrated an increased risk of death with the use of sirolimus eluting stents (SES), cautioning the interventional cardiology community regarding the use of DES in SVG lesions [10].…”

A Randomized Controlled Trial of a Paclitaxel-Eluting Stent Versus a Similar Bare-Metal Stent in Saphenous Vein Graft Lesions

“…Two prospective, randomized, single-center studies have reported comparisons of DES and BMS in SVG lesions. In a post hoc subgroup analysis of the BASKET (Basel Stent Kosten Effektivitats Trial) study, the subgroup of 47 patients who underwent SVG PCI derived greater benefit from DES implantation during a follow-up of 18 months (24). In the BASKET study, major adverse cardiac events occurred in 62% in the BMS group versus 21% in the DES group (p ϭ 0.007), mainly due to a lower TVR rate in the DES group (46% vs. 18%, p ϭ 0.04).…”

Drug-Eluting or Bare Metal Stents for the Treatment of Saphenous Vein Graft Disease

“…26,33 One study abstract was found after reviewing major meetings' programs. 35 Finally, 25 studies (22 observational, 14 -33,35,36 2 randomized, controlled trials, 12,13 and 1 secondary subgroup analysis of a randomized, controlled trial 37 ) were included in this study-level meta-analysis (Figure 1). The main characteristics of the 25 studies are shown in Table 1.…”

“…Periprocedural treatment with clopidogrel was more disparate among eligible studies. In most trials, clopidogrel was prescribed for at least 1 month after BMS placement 13,[17][18][19][21][22][23]25,[27][28][29]36 and for at least 3 18 -20,22,25,28 or 6 months 13,14,17,19,21,23,25,27,28,32,33,36,37 after DES implantation. In the DELAYED RISCC study, 12 clopidogrel was administered for at least 2 months in all patients.…”