Long-term safety and effectiveness of drug-eluting stents for the treatment of saphenous vein grafts disease: a population-based study
Ko DT, Guo H, Wijeysundera HC, Zia MI, Dzavik V, Chu MW, Fremes SE, Cohen EA, Tu JV. JACC Cardiovasc Interv. 2011; 4(9):965-73.
Objectives — The purpose of this study was to evaluate the long-term safety and effectiveness of drug-eluting stents (DES) for the treatment of saphenous vein graft (SVG) disease.
Background — DES are frequently implanted for SVG interventions, but some studies have shown that they are not effective in reducing target vessel revascularization (TVR) over longer-term follow-up. Some studies suggest there is increased mortality with DES compared with bare-metal stents (BMS).
Methods — The authors performed propensity score matching analysis using a population-based cohort that included 709 well-matched pairs (n = 1,418) who received DES or BMS for the treatment of SVG disease from 2003 to 2008. Outcomes of interest included repeat TVR, myocardial infarction, and death.
Results — The mean age of the propensity-matched cohort was 69 years, 50% had diabetes, and the mean age of SVG was 10.6 years. At 4-year follow-up, the rate of repeat TVR was 21% in the DES group and 27.6% in the BMS group (p = 0.004). DES implantation was associated with the largest TVR reduction among patients with diabetes and patients receiving longer stents (≥30 mm) and the number of procedures needed to prevent a TVR at 4 years was 8 and 7, respectively. The composite rate of myocardial infarction or death was not significantly different between DES and BMS at 4 years (27.8% vs. 32.6%, p = 0.09).
Conclusions — Implantation of DES in the treatment of SVG disease is associated with substantial reduction of repeat revascularization, without evidence of an increased risk of myocardial infarction or death at longer-term follow-up.
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Coronary disease/Myocardial infarction