Late outcomes of drug eluting and bare metal stents in saphenous vein graft percutaneous coronary intervention

Abstract

Late outcomes of drug eluting and bare metal stents in saphenous vein graft percutaneous coronary intervention.Aims: PCI with drug eluting stents (DES) has been shown to reduce restenosis and major adverse cardiac event (MACE) rates compared to bare metal stents (BMS) in native coronary vessels, although outcomes in saphenous vein graft (SVG) lesions are less clear. We retrospectively studied 388 consecutive patients admitted to our centre for SVG PCI to assess mortality and MACE outcomes (defined as composite endpoint of all-death, stroke, myocardial infarction, stent thrombosis and target lesion (TLR) / vessel (TVR) revascularisation) associated with BMS and DES use. Methods and results:Two hundred and nineteen (219) patients had BMS and 169 had DES (total 388 patients). Mean follow up was 41.9±23.5 months. No significant differences were observed in mortality (14.2% vs. 11.8%) or MACE (37.6% vs. 35.8%) between the BMS and DES groups at four years follow-up or at other intervening time points studied. Similarly, no differences in TVR / TLR rates were observed over a similar time period (19.8% vs. 21.6%). Conclusions:We have observed that DES and BMS use in SVG PCI have comparable mortality and MACE rates, and that in contrast to PCI in native coronary arteries, DES do not reduce revascularisation rates in our study cohort.

A Comparison of Drug-Eluting Stents versus Bare Metal Stents in Saphenous Vein Graft PCI Outcomes: A Meta-Analysis

“…It is possible that there is an element of selection bias, for example, in the largest registry study involving over 1,000 patients 32 which also showed a mortality benefit associated with DES use, BMS were used in greater frequency than DES in more acute settings such as STEMI and “emergency” cases. In contrast, studies such as that of Lee et al 14 illustrated that DES were used more commonly in emergent cases presenting with acute coronary syndrome while other studies used in this analysis have shown that BMS and DES where used in similar frequencies in the acute setting 10,12,15,17,18,30,31 …”

“…Separate meta‐analysis of the randomized controlled trials 6,7 did not reveal any mortality benefit/adverse effect associated with DES use (OR 6.7; 95% CI 0.62–74.14; P = 0.12), although a separate meta‐analysis of data from registry studies alone 9–16 , 18,22 , 24–28 , 30–32 showed a similar reduction in the risk of mortality to the pooled analysis associated with the use of DES (OR 0.60; 95% CI 0.50–0.73; P < 0.0001).…”

“…Using the methodology described, a total of 23 studies were identified 6–16 , 18 , 22–32 . Three of these studies were excluded from the analysis since total mortality rates were not presented 8,23,29 .…”

“…Three of these studies were excluded from the analysis since total mortality rates were not presented 8,23,29 . The remaining 20 studies involved 5,296 patients consisting of two randomized controlled trials 6,7 and 18 registry studies 9–16 , 18,22 , 24–28 , 30–32 . These are summarized in Table 1.…”

“…Registry study data have also been inconsistent with studies showing either no difference 8–13,30 or reduced mortality rates 14,32 comparing DES and BMS. We show a significant decrease in mortality associated with DES use driven by a decrease in mortality among registry studies (although no effects on mortality were seen in meta‐analyzing the two RCTs alone 6,7 ).…”