Long-Term Outcomes With Drug-Eluting Stents Versus Bare Metal Stents in the Treatment of Saphenous Vein Graft Disease (Results from the REgistro Regionale AngiopLastiche Emilia-Romagna Registry)

Vignali, Luigi; Saia, Francesco; Manari, Antonio; Santarelli, Andrea; Rubboli, Andrea; Varani, Elisabetta; Piovaccari, Giancarlo; Menozzi, Alberto; Percoco, Gianfranco; Benassi, Alberto; Rusticali, Guido; Marzaroli, Paolo; Guastaroba, Paolo; Grilli, Roberto; Maresta, A; Marzocchi, Antonío

doi:10.1016/j.amjcard.2007.11.055

Cited by 41 publications

(39 citation statements)

References 16 publications

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“…This finding mirrors what other published comparison data have found [20][21][22][23][24], and yet it seemingly conflicts with the widely accepted superiority of DES over BMS for restenosis reduction in native vessels. One possible reason for the equivalent restenosis rates in grafts may be that DES are selectively placed in smaller diameter vessels, and BMS in larger vessels, due to differences in commercially available stent sizes.…”

Section: Discussionsupporting

confidence: 77%

“…The efficacy of DES in SVG remains uncertain due to contradictory data that supports lower rates of revascularization with DES [11][12][13][14][15][16][17][18][19]; clinical equivalence to BMS [20][21][22][23][24]; or even an excess of clinical events associated with the use of DES in SVG disease [25][26][27]. Indeed, the DELAYED RRISC trial showed increased mortality in patients treated with DES.…”

Section: Introductionmentioning

confidence: 99%

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Long‐term outcomes of drug‐eluting stents versus bare‐metal stents in saphenous vein graft disease: Results from the Prairie “Real World” Stent Registry

Goswami

Gaffigan

Berrio

et al. 2009

Cathet Cardio Intervent

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Objectives: This study was designed to compare long-term clinical outcomes of drugeluting stents (DES) versus bare metal stents (BMS) in patients with saphenous vein graft (SVG) disease in the ''real world.'' Background: The safety and efficacy of DES versus BMS in SVG remains uncertain due to contradictory reports of either lower revascularization rates with DES; or clinical equivalence to BMS; or even an excess of clinical events associated with DES use. Methods: We identified consecutive patients who underwent stent placement within a de novo SVG lesion between May 1, 2003 and July 31, 2007. Follow-up was obtained at regular intervals. The Kaplan-Meier method was used to produce actuarial survival estimates. Cox regression analysis was used to predict the risk associated with stent type, and propensity scores were generated to risk-adjust the results. Results: The study group included 379 stent recipients (284 DES; 95 BMS) with 410 stented lesions. BMS were placed more frequently in current smokers, acute myocardial infarctions, larger vessels, and longer lesions. In-hospital mortality was higher in BMS recipients than in their DES counterparts (3.2% vs. 0, respectively; P 5 0.015). At 3 years, there was no significant difference in clinical adverse event rates between DES and BMS recipients, even after risk adjustment. Conclusions: Three-year adverse event rates are similar among patients treated with DES or BMS in SVG lesions. Therefore, while DES are safe, they do not appear to offer an advantage in terms of long-term graft patency. V C 2009 Wiley-Liss, Inc.

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Section: Discussionsupporting

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Long‐term outcomes of drug‐eluting stents versus bare‐metal stents in saphenous vein graft disease: Results from the Prairie “Real World” Stent Registry

Goswami

Gaffigan

Berrio

et al. 2009

Cathet Cardio Intervent

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“…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.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

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

Paradis

Bélisle²,

Joseph³

et al. 2010

Circ: Cardiovascular Interventions

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Background-Observational studies and randomized, controlled trials have yielded uncertain results regarding the benefits of drug-eluting stents (DES) for the treatment of saphenous vein graft (SVG) disease. The objective of this meta-analysis was to assess the cumulative evidence regarding the efficacy and effectiveness of DES to treat SVG compared with bare metal stent (BMS When combining these outcomes, the OR for major adverse cardiac events was reduced in patients treated with DES (OR, 0.62; 95% CrI, 0.46 to 0.81). Finally, the relative risk of stent thrombosis appeared lower with DES, although again the CrIs were very wide (OR, 0.54; 95% CrI, 0.13 to 1.39). Conclusions-In this study-level meta-analysis, the largest ever reported and the first using bayesian methods, the use of DES for the treatment of SVG disease reduces target vessel revascularization and target lesion revascularization procedures compared with BMS. Although there is no evidence to date to suggest increased rates of mortality, myocardial infarction, or stent thrombosis, further data are needed to address this safety issue. (Circ Cardiovasc Interv. 2010;3:565-576.)

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“…7 Depois desses estudos randomizados iniciais realizados em pequenos grupos, foram apresentadas muitas séries de populações do mundo real com lesões em EVS. [11][12][13][14][15][16][17][18][19][20] Recentemente foram publicadas duas metaanálises de ensaios randomizados e estudos observacionais, abrangendo mais de 5 mil pacientes. Meir et al 21 relataram taxas semelhantes de morte, IM e RLA em pacientes tratados com stents farmacológicos e stents não-farmacológicos em ensaios randomizados.…”

Section: Discussionunclassified

Stents farmacológicos vs. stents não-farmacológicos no tratamento de enxertos de veia safena

Collet¹,

Costa²,

Sousa³

et al. 2011

Rev. Bras. Cardiol. Invasiva

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RESUMOIntrodução: Embora os stents farmacológicos tenham reduzido acentuadamente a reestenose e a necessidade de novas revascularizações na maioria dos cenários clínicos e angiográficos, o benefício desses dispositivos no tratamento de lesões em enxertos de veia safena (EVS) ainda precisa ser definido. O objetivo deste estudo foi comparar a incidência de eventos cardíacos adversos maiores (ECAM) entre stents farmacológicos e stents não-farmacológicos em lesões em EVS em pacientes não-selecionados. Métodos: Foram incluídos pacientes tratados em dois hospitais terciários entre maio de 2006 e janeiro de 2009. O objetivo primá-rio foi comparar a incidência de ECAM entre stents farmacológicos e stents não-farmacológicos durante a hospitalização e no seguimento a longo prazo. Resultados: No total, foram incluídos, consecutivamente, 308 pacientes, divididos de acordo com o tipo de stent implantado (209 com stents farmacológicos e 99 com stents não-farmacológicos). A média de idade do grupo foi de 68 anos e a dos EVS, de 10,9 anos. Na fase intra-hospitalar, houve tendência para maior incidência de ECAM no grupo que recebeu stents farmacológicos (12% vs. 5,1%; P = 0,06). Até 24 meses, a incidência de ECAM foi equivalente nos dois grupos (17,2% no grupo stents farmacológicos vs. 18,2% no grupo stents não-farmacológicos; P = 0,87). Trombose do stent definitiva/provável foi semelhante em ambos os grupos (2,3% no grupo stents farmacológicos vs. 2% no grupo stents não-farmacológicos; P = 0,94). Conclusões: Nesta série de pacientes complexos do mundo real, não houve preocupação com a segurança a longo prazo relacionada ao uso de stents farmacológicos no tratamento de lesões em EVS, com incidências similares de morte cardíaca/infarto do miocárdio/trombose do stent em ambos os grupos. DESCRITORES:Stents. Stents farmacológicos. Veia safena. ABSTRACT Drug-Eluting Stents vs. Bare-Metal Stents in Saphenous Vein Graft LesionsBackground: Although drug-eluting stents have markedly reduced restenosis and the need for repeat lesion revascularization in the vast majority of clinical and angiographic scenarios, the benefit of these devices for the treatment of saphenous-vein graft (SVG) lesions is yet to be defined. The aim of our study was to compare the rate of major adverse clinical events (MACE) between drug-eluting stents and bare-metal stents in SVG lesions in non-selected patients. Methods: Patients treated in two tertiary hospitals betweenMay 2006 and January 2009 were included. The primary objective was to compare the incidence of MACE between drug-eluting stents and bare-metal stents during hospitalization and in the long-term follow-up. Results: Overall, 308 patients were consecutively enrolled and divided according to the type of stent deployed (209 with drug-eluting stents and 99 with bare-metal stents). Mean age was 68 years and SVG mean age was 10.9 years. In the in-hospital phase there was a trend towards higher MACE in the drug-eluting stents group (12% vs. 5.1%; P = 0.06). The incidence of MACE in up to 24 months was equi...

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Long-Term Outcomes With Drug-Eluting Stents Versus Bare Metal Stents in the Treatment of Saphenous Vein Graft Disease (Results from the REgistro Regionale AngiopLastiche Emilia-Romagna Registry)

Cited by 41 publications

References 16 publications

Long‐term outcomes of drug‐eluting stents versus bare‐metal stents in saphenous vein graft disease: Results from the Prairie “Real World” Stent Registry

Long‐term outcomes of drug‐eluting stents versus bare‐metal stents in saphenous vein graft disease: Results from the Prairie “Real World” Stent Registry

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

Stents farmacológicos vs. stents não-farmacológicos no tratamento de enxertos de veia safena

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