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Latib A, Ferri L, Ielasi A, Cosgrave J, Godino C, Bonizzoni E, Romagnoli E, Chieffo A, Valgimigli M, Penzo C, Carlino M, Michev I, Sangiorgi GM, Montorfano M, Airoldi F, Colombo A. Comparison of the Long-Term Safety and Efficacy of Drug-Eluting and Bare-Metal Stent Implantation in Saphenous Vein Grafts. Circ Cardiovasc Interv 2010; 3:249-56. [DOI: 10.1161/circinterventions.109.929042] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Concerns about the long-term safety of drug-eluting stents (DES) in saphenous vein grafts has become an area of controversy and uncertainty.
Methods and Results—
In this retrospective registry, we compared the outcomes in 127 patients (143 lesions) treated with DES from April 2002 to June 2006 (DES group) with 131 patients (160 lesions) treated with bare-metal stents in the preceding 36 months (bare-metal stent group). End points analyzed were cumulative death, myocardial infarction, and target vessel revascularization at 2 years after stent implantation. The DES group was significantly (
P
<0.05) more complex with a greater frequency of diabetes (33.1%versus 15.3%), older grafts (11.6±5.3 years versus 9.6±5.2 years), restenotic lesions (23.8% versus 4.4%), total occlusions (7.7% versus 1.2%), and smaller grafts (3.16±0.66 mm versus 3.44±0.76 mm) treated with longer stents (34.1±25.1 mm versus 22.7±11.6 mm). At 2 years, there was no statistical difference in death (8.7% versus 7.8%), myocardial infarction (6.3% versus 9.4%), or target vessel revascularization (19.7% versus 24.2%) between DES and bare-metal stents, respectively. A propensity analysis to adjust for baseline differences suggested that there was no observed association between DES and increased mortality (hazard ratio, 0.72; 95% CI, 0.21 to 2.44;
P
=0.60) but possibly an association with a reduction in target vessel revascularization (hazard ratio, 0.31; 95% CI, 0.14 to 0.66;
P
=0.002).
Conclusions—
Despite being implanted in patients and lesions more complex than the bare-metal stent group, there was no observed association between DES implantation in saphenous vein grafts and an increase in late mortality. DES may maintain their efficacy in reducing revascularization rates in diseased saphenous vein grafts over a 2-year follow-up period.
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Affiliation(s)
- Azeem Latib
- From the Interventional Cardiology Unit (A.L., L.F., A.I., C.G., E.R., A.C., M.C., I.M., M.M., F.A., A.C.), San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit (A.L., J.C., C.G., G.M.S., F.A., A.C.), EMO-GVM Centro Cuore Columbus, Milan, Italy; Division of Cardiology (A.L.), University of Cape Town, Cape Town, South Africa; Institute of Medical Statistics and Biometry (E.B.), University of Milan, Milan, Italy; and Cardiovascular Institute (M.V., C.P.), University of
| | - Luca Ferri
- From the Interventional Cardiology Unit (A.L., L.F., A.I., C.G., E.R., A.C., M.C., I.M., M.M., F.A., A.C.), San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit (A.L., J.C., C.G., G.M.S., F.A., A.C.), EMO-GVM Centro Cuore Columbus, Milan, Italy; Division of Cardiology (A.L.), University of Cape Town, Cape Town, South Africa; Institute of Medical Statistics and Biometry (E.B.), University of Milan, Milan, Italy; and Cardiovascular Institute (M.V., C.P.), University of
| | - Alfonso Ielasi
- From the Interventional Cardiology Unit (A.L., L.F., A.I., C.G., E.R., A.C., M.C., I.M., M.M., F.A., A.C.), San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit (A.L., J.C., C.G., G.M.S., F.A., A.C.), EMO-GVM Centro Cuore Columbus, Milan, Italy; Division of Cardiology (A.L.), University of Cape Town, Cape Town, South Africa; Institute of Medical Statistics and Biometry (E.B.), University of Milan, Milan, Italy; and Cardiovascular Institute (M.V., C.P.), University of
| | - John Cosgrave
- From the Interventional Cardiology Unit (A.L., L.F., A.I., C.G., E.R., A.C., M.C., I.M., M.M., F.A., A.C.), San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit (A.L., J.C., C.G., G.M.S., F.A., A.C.), EMO-GVM Centro Cuore Columbus, Milan, Italy; Division of Cardiology (A.L.), University of Cape Town, Cape Town, South Africa; Institute of Medical Statistics and Biometry (E.B.), University of Milan, Milan, Italy; and Cardiovascular Institute (M.V., C.P.), University of
| | - Cosmo Godino
- From the Interventional Cardiology Unit (A.L., L.F., A.I., C.G., E.R., A.C., M.C., I.M., M.M., F.A., A.C.), San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit (A.L., J.C., C.G., G.M.S., F.A., A.C.), EMO-GVM Centro Cuore Columbus, Milan, Italy; Division of Cardiology (A.L.), University of Cape Town, Cape Town, South Africa; Institute of Medical Statistics and Biometry (E.B.), University of Milan, Milan, Italy; and Cardiovascular Institute (M.V., C.P.), University of
| | - Erminio Bonizzoni
- From the Interventional Cardiology Unit (A.L., L.F., A.I., C.G., E.R., A.C., M.C., I.M., M.M., F.A., A.C.), San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit (A.L., J.C., C.G., G.M.S., F.A., A.C.), EMO-GVM Centro Cuore Columbus, Milan, Italy; Division of Cardiology (A.L.), University of Cape Town, Cape Town, South Africa; Institute of Medical Statistics and Biometry (E.B.), University of Milan, Milan, Italy; and Cardiovascular Institute (M.V., C.P.), University of
| | - Enrico Romagnoli
- From the Interventional Cardiology Unit (A.L., L.F., A.I., C.G., E.R., A.C., M.C., I.M., M.M., F.A., A.C.), San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit (A.L., J.C., C.G., G.M.S., F.A., A.C.), EMO-GVM Centro Cuore Columbus, Milan, Italy; Division of Cardiology (A.L.), University of Cape Town, Cape Town, South Africa; Institute of Medical Statistics and Biometry (E.B.), University of Milan, Milan, Italy; and Cardiovascular Institute (M.V., C.P.), University of
| | - Alaide Chieffo
- From the Interventional Cardiology Unit (A.L., L.F., A.I., C.G., E.R., A.C., M.C., I.M., M.M., F.A., A.C.), San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit (A.L., J.C., C.G., G.M.S., F.A., A.C.), EMO-GVM Centro Cuore Columbus, Milan, Italy; Division of Cardiology (A.L.), University of Cape Town, Cape Town, South Africa; Institute of Medical Statistics and Biometry (E.B.), University of Milan, Milan, Italy; and Cardiovascular Institute (M.V., C.P.), University of
| | - Marco Valgimigli
- From the Interventional Cardiology Unit (A.L., L.F., A.I., C.G., E.R., A.C., M.C., I.M., M.M., F.A., A.C.), San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit (A.L., J.C., C.G., G.M.S., F.A., A.C.), EMO-GVM Centro Cuore Columbus, Milan, Italy; Division of Cardiology (A.L.), University of Cape Town, Cape Town, South Africa; Institute of Medical Statistics and Biometry (E.B.), University of Milan, Milan, Italy; and Cardiovascular Institute (M.V., C.P.), University of
| | - Carlo Penzo
- From the Interventional Cardiology Unit (A.L., L.F., A.I., C.G., E.R., A.C., M.C., I.M., M.M., F.A., A.C.), San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit (A.L., J.C., C.G., G.M.S., F.A., A.C.), EMO-GVM Centro Cuore Columbus, Milan, Italy; Division of Cardiology (A.L.), University of Cape Town, Cape Town, South Africa; Institute of Medical Statistics and Biometry (E.B.), University of Milan, Milan, Italy; and Cardiovascular Institute (M.V., C.P.), University of
| | - Mauro Carlino
- From the Interventional Cardiology Unit (A.L., L.F., A.I., C.G., E.R., A.C., M.C., I.M., M.M., F.A., A.C.), San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit (A.L., J.C., C.G., G.M.S., F.A., A.C.), EMO-GVM Centro Cuore Columbus, Milan, Italy; Division of Cardiology (A.L.), University of Cape Town, Cape Town, South Africa; Institute of Medical Statistics and Biometry (E.B.), University of Milan, Milan, Italy; and Cardiovascular Institute (M.V., C.P.), University of
| | - Iassen Michev
- From the Interventional Cardiology Unit (A.L., L.F., A.I., C.G., E.R., A.C., M.C., I.M., M.M., F.A., A.C.), San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit (A.L., J.C., C.G., G.M.S., F.A., A.C.), EMO-GVM Centro Cuore Columbus, Milan, Italy; Division of Cardiology (A.L.), University of Cape Town, Cape Town, South Africa; Institute of Medical Statistics and Biometry (E.B.), University of Milan, Milan, Italy; and Cardiovascular Institute (M.V., C.P.), University of
| | - Giuseppe M. Sangiorgi
- From the Interventional Cardiology Unit (A.L., L.F., A.I., C.G., E.R., A.C., M.C., I.M., M.M., F.A., A.C.), San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit (A.L., J.C., C.G., G.M.S., F.A., A.C.), EMO-GVM Centro Cuore Columbus, Milan, Italy; Division of Cardiology (A.L.), University of Cape Town, Cape Town, South Africa; Institute of Medical Statistics and Biometry (E.B.), University of Milan, Milan, Italy; and Cardiovascular Institute (M.V., C.P.), University of
| | - Matteo Montorfano
- From the Interventional Cardiology Unit (A.L., L.F., A.I., C.G., E.R., A.C., M.C., I.M., M.M., F.A., A.C.), San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit (A.L., J.C., C.G., G.M.S., F.A., A.C.), EMO-GVM Centro Cuore Columbus, Milan, Italy; Division of Cardiology (A.L.), University of Cape Town, Cape Town, South Africa; Institute of Medical Statistics and Biometry (E.B.), University of Milan, Milan, Italy; and Cardiovascular Institute (M.V., C.P.), University of
| | - Flavio Airoldi
- From the Interventional Cardiology Unit (A.L., L.F., A.I., C.G., E.R., A.C., M.C., I.M., M.M., F.A., A.C.), San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit (A.L., J.C., C.G., G.M.S., F.A., A.C.), EMO-GVM Centro Cuore Columbus, Milan, Italy; Division of Cardiology (A.L.), University of Cape Town, Cape Town, South Africa; Institute of Medical Statistics and Biometry (E.B.), University of Milan, Milan, Italy; and Cardiovascular Institute (M.V., C.P.), University of
| | - Antonio Colombo
- From the Interventional Cardiology Unit (A.L., L.F., A.I., C.G., E.R., A.C., M.C., I.M., M.M., F.A., A.C.), San Raffaele Scientific Institute, Milan, Italy; Interventional Cardiology Unit (A.L., J.C., C.G., G.M.S., F.A., A.C.), EMO-GVM Centro Cuore Columbus, Milan, Italy; Division of Cardiology (A.L.), University of Cape Town, Cape Town, South Africa; Institute of Medical Statistics and Biometry (E.B.), University of Milan, Milan, Italy; and Cardiovascular Institute (M.V., C.P.), University of
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