Drug-Eluting Stents vs. Bare Metal Stents in Saphenous Vein Graft Disease - Insights From a Meta-Analysis of 7,090 Patients -

Abstract

Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp rug-eluting stents (DES) are a major advance in interventional cardiology, but evidence in favor of their use in aortocoronary saphenous vein graft (SVG) disease, a common "off-label" indication for DES implantation in daily practice, is controversial. SVGs have a high occlusion rate 1,2 and percutaneous coronary intervention (PCI) with bare metal stent (BMS) implantation was the preferred treatment for SVG lesions 3-5 until the availability of DES, although the results were far from optimal. 4-7 DES are well known to be effective in reducing target vessel revascularization (TVR) in native vessels, 8-10 but concerns about a higher risk of late and very late stent thrombosis have been raised. 11 Nevertheless, the degeneration of SVG is quite a different phenomenon compared with progression of coronary artery atherosclerosis in native vessels. 12,13 Therefore, the outcome of DES in native coronary artery disease cannot be directly translated to this different clinical setting. 14 Previous nonrandomized studies as well as a few randomized controlled trials suggested that DES could substantially reduce the rate of re-intervention in SVG disease, 15-38 but reported data on mortality are conflicting 39 and biased by low statistical power. 14 Editorial p 261The aim of the present study was to perform a meta-analysis of both randomized and observational studies, comparing DES vs. BMS treatment in patients with SVG disease.

Percutaneous Intervention Post Coronary Artery Graft Surgery in Patients with Saphenous Vein Graft Disease – State of the Art

“…However, in this patient population, clear benefits from the use of drug-eluting stents in the reduction of death and myocardial infarction were not observed (Lupi et al, 2011).…”

“…Saphenous vein graft disease represents the "Achilles heel" of coronary artery bypass surgery interventions, due to the high failure rate of saphenous vein grafts (Lupi et al, 2011).…”

“…Stenosed saphenous vein grafts can be treated by percutaneous intervention or a second coronary artery bypass surgery; however, a repeated bypass surgery is burdened by a higher risk of death and provides less symptomatic improvement (Lupi et al, 2011).…”

“…Patients with previous coronary artery bypass graft surgery suffer from diffuse atherosclerosis of native coronary arteries a s w e l l a s r a p i d s a p h e n o u s v e i n g r a f t degeneration, thus the benefit from drug-eluting stents could be largely diluted by acute coronary syndromes arising from other previously untreated coronary lesions (Lupi et al, 2011).…”

The Final Answer?

“…4 They concluded that, in SVG disease, DES significantly reduced TVR, but they did not provide clear benefits on mortality and MI, with an opposite direction of the results for mortality observed from randomized and nonrandomized observational data.…”