Long‐term outcomes with first‐ vs. second‐generation drug‐eluting stents in saphenous vein graft lesions

Pokala, Nagendra R.; Menon, Rohan; Patel, Siddharth; Christopoulos, George; Christakopoulos, Georgios E.; Kotsia, Anna; Rangan, Bavana V.; Roesle, Michele; Abdullah, Shuaib; Grodin, Jerrold; Kumbhani, Dharam J.; Hastings, Jeffrey L.; Banerjee, Subhash; Brilakis, Emmanouil S.

doi:10.1002/ccd.25982

Cited by 17 publications

(12 citation statements)

References 35 publications

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“…In comparison with first‐generation DES, newer DES have shown better safety and efficacy in native coronary arteries . The comparison outcome of first‐generation vs second‐generation DES in SVG lesions has shown similar long‐term outcomes . In a cohort study of 2471 patients comparing DES vs BMS in SVG PCI at all Veterans Affairs hospitals, second‐generation DES had lower mortality rates in comparison with first‐generation DES, but the difference was not statistically significant .…”

Section: Discussionmentioning

confidence: 99%

The short‐ and long‐term outcomes of percutaneous intervention with drug‐eluting stent vs bare‐metal stent in saphenous vein graft disease: An updated meta‐analysis of all randomized clinical trials

Kheiri

Osman

Abdalla

et al. 2018

Clinical Cardiology

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The use of drug-eluting stents (DES) vs bare-metal stents (BMS) in saphenous vein graft (SVG) lesions remains controversial. We conducted a meta-analysis of all randomized clinical trials comparing the outcomes of DES with BMS in SVG percutaneous coronary interventions. A search of PubMed, Embase, the Cochrane Register of Controlled Trials, and Clinicaltrials.gov was performed for all randomized clinical trials. We evaluated the short- and long-term clinical outcomes of the following: all-cause mortality, major adverse cardiovascular events (MACE), definite/probable stent thrombosis, target lesion revascularization (TLR), and target-vessel revascularization (TVR). From a total of 1582 patients in 6 randomized clinical trials, 797 had DES and 785 had BMS. Patients with DES had lower short-term MACE, TLR, and TVR in comparison with BMS (odds ratio [OR]: 0.56, 95% confidence interval [CI]: 0.35-0.91, P = 0.02; OR: 0.43, 95% CI: 0.19-0.99, P = 0.05; and OR: 0.45, 95% CI: 0.22-0.95, P = 0.04, respectively). However, there were no different outcomes for all-cause mortality (P = 0.63) or stent thrombosis (P = 0.21). With long-term follow-up, there were no significant reductions of MACE (P = 0.20), TLR (P = 0.57), TVR (P = 0.07), all-cause mortality (P = 0.29), and stent thrombosis (P = 0.76). The use of DES in SVG lesions was associated with lower short-term MACE, TLR, and TVR in comparison with BMS. However, there were no significant differences with long-term follow-up.

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Section: Discussionmentioning

confidence: 99%

The short‐ and long‐term outcomes of percutaneous intervention with drug‐eluting stent vs bare‐metal stent in saphenous vein graft disease: An updated meta‐analysis of all randomized clinical trials

Kheiri

Osman

Abdalla

et al. 2018

Clinical Cardiology

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“…Fourth, use of EPDs was low in most studies (<5% in ISAR‐CABG); EPDs have been shown to reduce the risk for periprocedural MI and could affect subsequent clinical outcomes. Fifth, 3 trials only included first‐generation DES; second‐generation DES have been shown to improve outcomes in de novo coronary lesions, although the results of retrospective SVG studies have been less consistent . Finally, prior CABG participants often have multiple comorbidities that may confound assessment of various treatment strategies, including stents…”

Section: Discussionmentioning

confidence: 99%

Rationale and design of the Drug‐Eluting Stents vs Bare‐Metal Stents in Saphenous Vein Graft Angioplasty (DIVA) Trial

Brilakis

Banerjee

Edson

et al. 2017

Clinical Cardiology

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VA Cooperative Studies Program #571 (DIVA) was designed to evaluate the efficacy of drugeluting stents (DES) for reducing aortocoronary saphenous vein bypass graft (SVG) failure when compared with bare-metal stents (BMS) in participants undergoing stenting of de novo SVG lesions. Participants undergoing clinically indicated stenting of de novo SVG lesions were randomized in a 1:1 ratio to DES or BMS. Randomization was stratified by presence/absence of diabetes mellitus and the number of target SVG lesions (1 vs ≥2) within each participating site.At sites that did not routinely administer 12-months of dual antiplatelet therapy after SVG stenting participants without acute coronary syndromes received 1 month of open-label clopidogrel, followed by 11 months of clopidogrel for those assigned to DES and 11 months of placebo for those assigned to BMS. The primary endpoint was the 12-month incidence of targetvessel failure (defined as the composite of cardiac death, target-vessel myocardial infarction, or target-vessel revascularization). Secondary endpoints included the incidence of other clinical endpoints and the incremental cost-effectiveness of DES relative to BMS. Due to lower-thananticipated target-vessel failure rates, target enrollment was increased from 519 to 762. The study had randomized 599 participants when recruitment ended in December 2015. The DIVA trial will provide clarity on the appropriate stent type for de novo SVG lesions.

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“…Two types of EES were available for use in the study: Xience V TM (Abbott Vascular, Santa Clara, CA, USA; diameters of 2.50, 2.75, 3.00, and 3.50 mm and lengths of 8,12,15,23, and 28 mm) and Promus Element TM (Boston Scientific, Natick, MA, USA; diameters of 2.50, 2.75, 3.00 and 3.50 mm and lengths of 8,12,16,20,24, and 28 mm). When loading of dual antiplatelet drugs was necessary, patients received 300 mg…”

Section: Methodsmentioning

confidence: 99%

“…Pokala, et al reported that second generation DES (69% EES) implantation failed to improve the 2-year followup TLR rate for SVG disease. 15) According to Sen, et al, revascularization rates were higher after second generation DES (50% EES) implantation for patients with a previous history of CABG because of repeated revascularizations after PCI of degenerated SVG. 7) Our data support findings that even second generation DES cannot eliminate revascularization after PCI in patients with a history of CABG.…”

Section: Nomura Et Almentioning

confidence: 99%

Three-Year Clinical and Angiographic Outcomes After Everolimus-Eluting Stent Implantation in Patients With a History of Coronary Artery Bypass Grafting

et al. 2016

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SummaryThe clinical and angiographic outcomes after percutaneous coronary intervention (PCI) with everolimus-eluting stent (EES) implantation in patients with a history of coronary artery bypass grafting (CABG) have yet to be fully investigated. The aim of the present study was to investigate 3-year clinical outcomes after EES implantation in patients with a history of CABG.We retrospectively enrolled 176 consecutive patients who had undergone EES implantation. Three-year clinical follow-up data were obtained from all patients. Follow-up angiograms and serial quantitative coronary angiography analysis (QCA) were performed for 139 (79.0%) patients. Patients from the prior CABG (+) group (n = 17; 9.7%) had higher incidences of target lesion revascularization (TLR; 41.2% versus 3.8%, P < 0.001) and major adverse cardiac events (47.1% versus 15.1%, P = 0.004). A landmark analysis conducted 1 year into our study showed a higher incidence of TLR in the prior CABG (+) group (20.0% versus 3.0%, P = 0.017).The reason for EES implantation in the prior CABG (+) group was saphenous vein graft (SVG) failure in 19 (79.2%) lesions, although the target vessel was the SVG in 8 (33.3%) lesions. There were no significant differences in clinical and follow-up QCA data between the native vessel and SVG PCI groups.This study revealed that a history of CABG was a risk factor for TLR after EES implantation. The major reason for PCI after CABG was SVG failure; both native vessel and SVG PCI showed poor outcomes. Further investigations may be warranted to determine which interventions are most effective in this high-risk subset. (Int Heart J 2016; 57: 158-166)

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Long‐term outcomes with first‐ vs. second‐generation drug‐eluting stents in saphenous vein graft lesions

Abstract: Outcomes with first- and second-generation DES in SVGs are similar. Novel stent designs are needed to further improve the clinical outcomes in this challenging patient and lesion subgroup. © 2015 Wiley Periodicals, Inc.

Cited by 17 publications

References 35 publications

The short‐ and long‐term outcomes of percutaneous intervention with drug‐eluting stent vs bare‐metal stent in saphenous vein graft disease: An updated meta‐analysis of all randomized clinical trials

The short‐ and long‐term outcomes of percutaneous intervention with drug‐eluting stent vs bare‐metal stent in saphenous vein graft disease: An updated meta‐analysis of all randomized clinical trials

Rationale and design of the Drug‐Eluting Stents vs Bare‐Metal Stents in Saphenous Vein Graft Angioplasty (DIVA) Trial

Three-Year Clinical and Angiographic Outcomes After Everolimus-Eluting Stent Implantation in Patients With a History of Coronary Artery Bypass Grafting

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