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Yang J, Chen Y, Li X, Xu D. New insights into the roles of glucocorticoid signaling dysregulation in pathological cardiac hypertrophy. Heart Fail Rev 2021; 27:1431-1441. [PMID: 34455516 DOI: 10.1007/s10741-021-10158-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2021] [Indexed: 01/02/2023]
Abstract
Pathological cardiac hypertrophy is a process of abnormal remodeling of the myocardium in response to stress overload or ischemia that results in myocardial injury, which is an independent risk factor for the increased morbidity and mortality of heart failure. Elevated circulating glucocorticoids (GCs) levels are associated with an increased risk of pathological cardiac hypertrophy, but the exact role remains unclear. In the heart, GCs exerts physiological and pharmacological effects by binding the glucocorticoid receptor (GR, NR3C1). However, under the state of tissue damage or oxidative stress, GCs can also bind the closely related mineralocorticoid receptor (MR, NR3C2) to exert a detrimental effect on cardiac function. In addition, the bioavailability of GCs at the cellular level is mainly regulated by tissue-specific metabolic enzymes 11β-hydroxysteroid dehydrogenases (11β-HSDs), including 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) and type 2 (11β-HSD2), which catalyze the interconversion of active GCs. In this paper, we provide an overview of GC signaling and its physiological roles in the heart and highlight the dynamic and diverse roles of GC signaling dysregulation, mediated by excessive ligand GCs levels, GR/MR deficiency or overexpression, and local GCs metabolic disorder by 11β-HSDs, in the pathology of cardiac hypertrophy. Our findings will provide new ideas and insights for the search for appropriate intervention targets for pathological cardiac hypertrophy.
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Affiliation(s)
- Jingmin Yang
- Department of Cardiology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410000, Hunan, China
| | - Yanying Chen
- Department of Cardiology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410000, Hunan, China
| | - Xiao Li
- Department of Cardiology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410000, Hunan, China
| | - Danyan Xu
- Department of Cardiology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, 410000, Hunan, China.
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2
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Fahrni G, Farah A, Engstrøm T, Galatius S, Eberli F, Rickenbacher P, Conen D, Mueller C, Pfister O, Twerenbold R, Coslovsky M, Cattaneo M, Kaiser C, Mangner N, Schuler G, Pfisterer M, Möbius-Winkler S, Jeger RV. Long-Term Results After Drug-Eluting Versus Bare-Metal Stent Implantation in Saphenous Vein Grafts: Randomized Controlled Trial. J Am Heart Assoc 2020; 9:e017434. [PMID: 33032485 PMCID: PMC7763393 DOI: 10.1161/jaha.120.017434] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Efficacy data on drug‐eluting stents (DES) versus bare‐metal stents (BMS) in saphenous vein grafts are controversial. We aimed to compare DES with BMS among patients undergoing saphenous vein grafts intervention regarding long‐term outcome. Methods and Results In this multinational trial, patients were randomized to paclitaxel‐eluting or BMS. The primary end point was major adverse cardiac events (cardiac death, nonfatal myocardial infarction, and target‐vessel revascularization at 1 year. Secondary end points included major adverse cardiac events and its individual components at 5‐year follow‐up. One hundred seventy‐three patients were included in the trial (89 DES versus 84 BMS). One‐year major adverse cardiac event rates were lower in DES compared with BMS (2.2% versus 16.0%, hazard ratio, 0.14; 95% CI, 0.03–0.64, P=0.01), which was mainly driven by a reduction of subsequent myocardial infarctions and need for target‐vessel revascularization. Five‐year major adverse cardiac event rates remained lower in the DES compared with the BMS arm (35.5% versus 56.1%, hazard ratio, 0.40; 95% CI, 0.23–0.68, P<0.001). A landmark‐analysis from 1 to 5 years revealed a persistent benefit of DES over BMS (hazard ratio, 0.33; 95% CI, 0.13–0.74, P=0.007) in terms of target‐vessel revascularization. More patients in the BMS group underwent multiple target‐vessel revascularization procedures throughout the study period compared with the DES group (DES 1.1% [n=1] versus BMS 9.5% [n=8], P=0.013). Enrollment was stopped before the target sample size of 240 patients was reached. Conclusions In this randomized controlled trial with prospective long‐term follow‐up of up to 5 years, DES showed a better efficacy than BMS with sustained benefits over time. DES may be the preferred strategy in this patient population. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00595647.
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Affiliation(s)
| | - Ahmed Farah
- Klinikum Westfalen Dortmund Germany.,Central Clinic Bad Berka Germany
| | | | - Søren Galatius
- Bispebjerg University Hospital Copenhagen Denmark.,Gentofte Hospital Hellerup Denmark
| | | | | | - David Conen
- University Hospital Basel Switzerland.,Population Health Research Institute McMaster University Hamilton Canada
| | | | | | | | | | | | | | - Norman Mangner
- Herzzentrum Dresden Technische Universität Dresden Dresden Germany.,Heart Center University of Leipzig Germany
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3
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Superior long term outcome associated with native vessel versus graft vessel PCI following secondary PCI in patients with prior CABG. Int J Cardiol 2017; 228:563-569. [DOI: 10.1016/j.ijcard.2016.11.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 08/10/2016] [Accepted: 11/05/2016] [Indexed: 12/21/2022]
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4
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Aggarwal V, Stanislawski MA, Maddox TM, Nallamothu BK, Grunwald G, Adams JC, Ho PM, Rao SV, Casserly IP, Rumsfeld JS, Brilakis ES, Tsai TT. Safety and Effectiveness of Drug-Eluting Versus Bare-Metal Stents in Saphenous Vein Bypass Graft Percutaneous Coronary Interventions. J Am Coll Cardiol 2014; 64:1825-36. [DOI: 10.1016/j.jacc.2014.06.1207] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 05/21/2014] [Accepted: 06/30/2014] [Indexed: 12/22/2022]
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Escárcega RO, Baker NC, Lipinski MJ, Magalhaes MA, Minha S, Omar AF, Torguson R, Waksman R. Current application and bioavailability of drug-eluting stents. Expert Opin Drug Deliv 2014; 11:689-709. [PMID: 24533457 DOI: 10.1517/17425247.2014.888054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Drug-eluting stents (DES) were developed to reduce the restenosis rate of bare metal stents (BMS) and comprises three main components: i) a metallic scaffold; ii) an antiproliferative drug to reduce or abolish the formation of the neointima; and iii) the polymer, which both enables and controls drug elution into the vessel wall. Over the years, growing evidence has been reported on the safety and efficacy for different indications of DES. AREAS COVERED Since the introduction of first-generation DES, the technology has been refined, including changes in the alloy, stent design, polymer, drug and drug dose. In 2014, we will usher in a third generation of DES, which will include biodegradable polymers, polymer-free DES and bioabsorbable scaffolds. EXPERT OPINION In recent years, considerable progress has been made in DES development. The BMS platform set the groundwork for the development of metal scaffolds with drug-eluting capability to prevent restenosis. Importantly, extensive research has shown long-term safety and efficacy of the newer generation DES. Available data suggest that DES can be safely and effectively used to treat a complex subset of patients and lesions, including patients presenting with acute myocardial infarction, lesions in saphenous vein grafts, chronic total occlusions, multivessel disease, small vessels, long lesions and bifurcations. One of the safety targets is to eliminate stent thrombosis.
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Affiliation(s)
- Ricardo O Escárcega
- Medstar Washington Hospital Center, Division of Cardiology , 110 Irving St. NW, Suite 4B1, Washington, DC 20009 , USA +1 202 877 2812 ; +1 202 877 2715 ;
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6
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Hougaard M, Thayssen P, Kaltoft A, Tilsted HH, Maeng M, Flensted Lassen J, Thuesen L, Okkels Jensen L. Long-term outcome following percutaneous coronary intervention with drug-eluting stents compared with bare-metal stents in saphenous vein graft lesions: From Western Denmark heart registry. Catheter Cardiovasc Interv 2013; 83:1035-42. [DOI: 10.1002/ccd.25279] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 10/02/2013] [Accepted: 10/23/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Mikkel Hougaard
- Department of Cardiology; Odense University Hospital; Odense Denmark
| | - Per Thayssen
- Department of Cardiology; Odense University Hospital; Odense Denmark
| | - Anne Kaltoft
- Department of Cardiology; Aarhus University Hospital; Skejby Aarhus Denmark
| | | | - Michael Maeng
- Department of Cardiology; Aarhus University Hospital; Skejby Aarhus Denmark
| | | | - Leif Thuesen
- Department of Cardiology; Aarhus University Hospital; Skejby Aarhus Denmark
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Foster C, Zajarias A. Degenerated Saphenous Vein Graft Intervention: Should We Target the Native Vessel instead? Interv Cardiol Clin 2013; 2:323-337. [PMID: 28582139 DOI: 10.1016/j.iccl.2012.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Coronary interventions of degenerated saphenous vein grafts (SVGs) continue to present a management challenge. Although repeat coronary artery bypass grafting (CABG) remains a significant risk factor for operative mortality, percutaneous coronary intervention (PCI) is still associated with a high risk for periprocedural events. There is a lack of consensus on the optimal treatment strategy for patients with severe stenosis of SVGs. It is imperative to review the characteristics of native versus SVG disease, risk factors for complications after SVG intervention, procedural treatment strategies important to the decision on which therapeutic strategy to follow, and measures to mitigate the risks of periprocedural complications.
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Affiliation(s)
- Corey Foster
- Cardiovascular Division, Department of Internal Medicine, Washington University School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA
| | - Alan Zajarias
- Cardiovascular Division, Department of Internal Medicine, Washington University School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA.
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8
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Yazdani SK, Farb A, Nakano M, Vorpahl M, Ladich E, Finn AV, Kolodgie FD, Virmani R. Pathology of drug-eluting versus bare-metal stents in saphenous vein bypass graft lesions. JACC Cardiovasc Interv 2012; 5:666-74. [PMID: 22721663 PMCID: PMC3407956 DOI: 10.1016/j.jcin.2011.12.017] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 12/07/2011] [Accepted: 12/22/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The purpose of this study was to assess the pathological responses of atherosclerotic saphenous vein bypass grafts (SVBGs) to drug-eluting stents (DES) versus bare-metal stents (BMS). BACKGROUND Repeat bypass surgery is typically associated with a high rate of morbidity and mortality. Percutaneous coronary interventions have emerged as the preferred treatment; however, only limited data are available on SVBGs pathological responses to DES and BMS. METHODS Formalin-fixed SVBG of >2 years duration (n = 31) were collected to histologically characterize advanced atherosclerotic lesions in native SVBG. In a separate group, SVBGs treated with DES (n = 9) and BMS (n = 9) for >30 days duration were assessed for morphological and morphometric changes. RESULTS Necrotic core lesions were identified in 25% of SVBG sections, and plaque rupture with luminal thrombosis was observed in 6.3% of histological sections (32% [10 of 31] vein grafts examined). Morphometry of DES demonstrated reduction in neointimal thickening versus BMS (0.13 mm [interquartile range: 0.06 to 0.16 mm] vs. 0.30 mm [interquartile range: 0.20 to 0.48 mm], p = 0.004). DES lesions also showed greater delayed healing characterized by increased peristrut fibrin deposition, higher percentage of uncovered struts, and less endothelialization compared with BMS. Stent fractures (DES 56% vs. BMS 11%, p = 0.045) and late stent thrombosis (DES 44% vs. BMS 0%, p = 0.023) were more common in DES versus BMS. CONCLUSIONS Advanced SVBG atherosclerotic lesions are characterized by large hemorrhagic necrotic cores. Stenting of such lesions is associated with delayed vascular healing and late thrombosis particularly following DES implantation, which may help explain the higher rates of cardiovascular events observed in SVBG stenting as compared with native coronary arteries.
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MESH Headings
- Aged
- Aged, 80 and over
- Angioplasty, Balloon, Coronary/adverse effects
- Angioplasty, Balloon, Coronary/instrumentation
- Angioplasty, Balloon, Coronary/mortality
- Atherosclerosis/etiology
- Atherosclerosis/mortality
- Atherosclerosis/pathology
- Atherosclerosis/therapy
- Autopsy
- Chi-Square Distribution
- Coronary Artery Bypass/adverse effects
- Coronary Artery Bypass/mortality
- Coronary Thrombosis/etiology
- Coronary Thrombosis/pathology
- Drug-Eluting Stents
- Female
- Fixatives
- Formaldehyde
- Graft Occlusion, Vascular/etiology
- Graft Occlusion, Vascular/mortality
- Graft Occlusion, Vascular/pathology
- Graft Occlusion, Vascular/therapy
- Humans
- Male
- Metals
- Middle Aged
- Necrosis
- Neointima
- Plaque, Atherosclerotic
- Prosthesis Design
- Prosthesis Failure
- Registries
- Risk Assessment
- Risk Factors
- Saphenous Vein/pathology
- Saphenous Vein/transplantation
- Stents
- Time Factors
- Tissue Fixation
- Treatment Outcome
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Affiliation(s)
| | - Andrew Farb
- Office of Device Evaluation, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, MD
| | | | | | | | - Aloke V. Finn
- Department of Cardiology, Emory University School of Medicine, Atlanta, GA
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Tolerico PH, Cohen DJ, Kleiman NS, Berger PB, Brilakis ES, Piana RN, Shammo S, Keyes MJ, Kennedy KF, Massaro JM, Saucedo JF. In-Hospital and 1-year outcomes with drug-eluting versus bare metal stents in saphenous vein graft intervention: A report from the EVENT registry. Catheter Cardiovasc Interv 2012; 80:1127-36. [DOI: 10.1002/ccd.24352] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 01/22/2012] [Indexed: 11/08/2022]
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10
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Mendiz OA, Ahmed WH, Fava CM, vom Dahl J, Valdivieso LR, Lev GA, R Thomas M. Clinical outcome after saphenous vein stenting with Taxus Liberté stent: results from the OLYMPIA Registry (TAXUS Liberté Postapproval Global Program). Angiology 2012; 63:574-8. [PMID: 22238352 DOI: 10.1177/0003319711430324] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We evaluated the incidence of clinical events after implantation of the TAXUS Liberté paclitaxel-eluting stent in saphenous vein graft (SVG) lesions in an unselected patient population. The OLYMPIA (TAXUS Liberté Post-Approval Global Registry) program gathered data on 21 954 patients receiving at least 1 TAXUS Liberté stent, including 345 patients with SVG lesions. All cardiac events were monitored with independent adjudication of end points. Patients enrolled at procedure started with no mandated inclusion/exclusion criteria. In SVG-OLYMPIA (n = 345), baseline comorbidities/complex disease were more frequent than the rest of the OLYMPIA (n = 21 560). SVG-OLYMPIA had similar cardiac death, target vessel revascularization, and definitive stent thrombosis rates than the rest of OLYMPIA. Despite higher baseline risk, the SVG-OLYMPIA had similar 12-month clinical outcome than the rest of the OLYMPIA registry, confirming the safety and efficacy of the TAXUS Liberté stent in this high-risk group.
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Affiliation(s)
- Oscar A Mendiz
- Hospital Universitario, Fundación Favaloro, Buenos Aires, Argentina.
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11
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Eagle S, Brophy CM, Komalavilas P, Hocking K, Putumbaka G, Osgood M, Sexton K, Leacche M, Cheung-Flynn J. Surgical Skin Markers Impair Human Saphenous Vein Graft Smooth Muscle and Endothelial Function. Am Surg 2011. [DOI: 10.1177/000313481107700732] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Marking human saphenous vein graft (HSV) with a surgical skin marker to prevent twisting on implantation is a common practice in peripheral and coronary artery bypass procedures. This study is designed to examine the effects of surgical skin markers on the HSV smooth muscle and endothelial functional responses. De-identified HSV remnants were collected during peripheral and coronary artery bypass procedures. Physiologic responses of the HSV were measured using a muscle bath. Veins that were marked with surgical skin markers intraoperatively generated significantly less contractile force to depolarizing KC1 (110 mM) and receptor-mediated contractile agonists than unmarked HSV, suggesting that surgical skin markers impaired HSV smooth muscle contractility. To directly access the effects of chemical components in the surgical skin markers, unmarked HSV was exposed to isopropyl alcohol (a solvent commonly used in surgical skin markers) or methylene blue (a dye). Smooth muscle contractility was significantly reduced by isopropyl alcohol and methylene blue. Endothelial-dependent relaxation to carbachol was significantly reduced after exposure to surgical skin markers. Our data demonstrated that marking HSV with surgical skin markers reduces smooth muscle and endothelial functional viability.
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Affiliation(s)
- Susan Eagle
- Departments of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Colleen M. Brophy
- Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Padmini Komalavilas
- Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Cardiac Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kyle Hocking
- Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Michael Osgood
- Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kevin Sexton
- Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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12
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Nair S, Fath-Ordoubadi F, Clarke B, El-Omar M, Foley J, Fraser DG, Mahadevan VS, Neyses L, Khattar RS, Mamas MA. Late outcomes of drug eluting and bare metal stents in saphenous vein graft percutaneous coronary intervention. EUROINTERVENTION 2011; 6:985-91. [PMID: 21330247 DOI: 10.4244/eijv6i8a170] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
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.
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Affiliation(s)
- Satheesh Nair
- Manchester Heart Centre, Manchester Royal Infirmary, Biomedical Research Centre, and Manchester Academic Health Science Center, University of Manchester, Manchester, United Kingdom
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Bundhoo SS, Kalla M, Anantharaman R, Morris K, Chase A, Smith D, Anderson RA, Kinnaird TD. Outcomes following PCI in patients with previous CABG. Catheter Cardiovasc Interv 2011; 78:169-76. [DOI: 10.1002/ccd.22841] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Accepted: 09/20/2010] [Indexed: 11/08/2022]
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MAMAS MAMASA, FOLEY JAMES, NAIR SATHEESH, WIPER ANDREW, CLARKE BERNARD, EL-OMAR MAGDI, FRASER DOUGLASG, KHATTAR RAJDEEP, NEYSES LUDWIG, FATH-ORDOUBADI FARZIN. A Comparison of Drug-Eluting Stents versus Bare Metal Stents in Saphenous Vein Graft PCI Outcomes: A Meta-Analysis. J Interv Cardiol 2011; 24:172-80. [DOI: 10.1111/j.1540-8183.2010.00620.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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15
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Lupi A, Navarese EP, Lazzero M, Sansa M, Servi SD, Serra A, Bongo AS, Buffon A. Drug-Eluting Stents vs. Bare Metal Stents in Saphenous Vein Graft Disease - Insights From a Meta-Analysis of 7,090 Patients -. Circ J 2011; 75:280-9. [DOI: 10.1253/circj.cj-10-0186] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Eliano Pio Navarese
- Istituto di Cardiologia, Università Cattolica del Sacro Cuore
- Interventional Cardiology Unit, Hospital de la Santa Creu i Sant Pau
| | | | - Mara Sansa
- Cardiologia 2, Ospedale Maggiore della Carità
| | | | - Antonio Serra
- Interventional Cardiology Unit, Hospital de la Santa Creu i Sant Pau
| | | | - Antonio Buffon
- Istituto di Cardiologia, Università Cattolica del Sacro Cuore
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16
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Wiisanen ME, Abdel-Latif A, Mukherjee D, Ziada KM. Drug-Eluting Stents Versus Bare-Metal Stents in Saphenous Vein Graft Interventions. JACC Cardiovasc Interv 2010; 3:1262-73. [PMID: 21232720 DOI: 10.1016/j.jcin.2010.08.019] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2010] [Revised: 08/18/2010] [Accepted: 08/30/2010] [Indexed: 11/25/2022]
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17
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Paradis JM, Bélisle P, Joseph L, Bertrand OF, DeLarochellière R, Déry JP, Larose E, Rodés-Cabau J, Rinfret S. Drug-eluting or bare metal stents for the treatment of saphenous vein graft disease: a Bayesian meta-analysis. Circ Cardiovasc Interv 2010; 3:565-76. [PMID: 21098743 DOI: 10.1161/circinterventions.110.949735] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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). METHODS AND RESULTS We conducted a bayesian hierarchical meta-analysis of all randomized, controlled trials and observational studies that compared clinical outcomes after DES or BMS placement in SVG disease. Our search resulted in 25 studies, cumulating 5755 patients. DES implantation was not associated with an increased risk of death (odds ratio [OR], 0.85; 95% credible intervals (CrI) [CrI], 0.62 to 1.21) or myocardial infarction (OR, 0.83; 95% CrI, 0.56 to 1.32), but wide CrIs preclude definitive conclusions. Target vessel revascularization (OR, 0.55; 95% CrI, 0.39 to 0.76) and target lesion revascularization (OR, 0.58; 95% CrI, 0.37 to 0.87) were both reduced by approximately 45% with DES. 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.
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Affiliation(s)
- Jean-Michel Paradis
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (Quebec Heart and Lung Institute), Quebec City, Canada
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18
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Hakeem A, Helmy T, Munsif S, Bhatti S, Mazraeshahi R, Cilingiroglu M, Effat M, Leesar M, Arif I. Safety and efficacy of drug eluting stents compared with bare metal stents for saphenous vein graft interventions: A comprehensive meta-analysis of randomized trials and observational studies comprising 7,994 patients. Catheter Cardiovasc Interv 2010; 77:343-55. [PMID: 21328679 DOI: 10.1002/ccd.22720] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 06/22/2010] [Accepted: 06/26/2010] [Indexed: 11/06/2022]
Affiliation(s)
- Abdul Hakeem
- Division of Cardiovascular diseases, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio 45257-0542, USA.
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Testa L, Agostoni P, Vermeersch P, Biondi-Zoccai G, Van Gaal W, Bhindi R, Brilakis E, Latini RA, Laudisa ML, Pizzocri S, Lanotte S, Brambilla N, Banning A, Bedogni F. Drug eluting stents versus bare metal stents in the treatment of saphenous vein graft disease: a systematic review and meta-analysis. EUROINTERVENTION 2010; 6:527-36. [PMID: 20884442 DOI: 10.4244/eij30v6i4a87] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Luca Testa
- Department of Interventional Cardiology, Istituto clinico S. Ambrogio, Milan, Italy.
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Beohar N, Meyers SN, Erdogan A, Harinstein ME, Pieper K, Gagnon S, Davidson CJ. Off-label use of drug-eluting versus bare metal stents: a lesion-specific systematic review of long-term outcomes. J Interv Cardiol 2010; 23:528-45. [PMID: 20735712 DOI: 10.1111/j.1540-8183.2010.00588.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The purpose of this systematic review was to evaluate differences in lesion-specific outcomes with the "off-label" use of drug-eluting stents (DES) versus bare metal stents (BMS). METHODS MEDLINE, PubMed, the Cochrane databases, and other Web were searched for studies evaluating off-label use of DES and BMS with the same characteristics. Of 1,258 abstracts or manuscripts reviewed, 112 studies were included (total N = 23,438). Studies were excluded if patients received both types of stent or no stent; lesion type was unknown; lesion-specific outcomes for ≥6 months were unavailable; or <25 patients were enrolled. RESULTS Overall mortality at 6-12 months was approximately 3% for BMS and DES for off-label use. Increase in mortality was greater from 6-12 months to 2 years with BMS than with DES (3.3%-9.1%; 2.8%-4.1%); however, rates were similar at 3 years (BMS: 18.8%; DES:15.3%). Myocardial Infarction rates were similar for both types at 6-12 months (BMS: 6.5%; DES: 6.0%). Overall rates of stent thrombosis were 1.8% and 1.7% for BMS and DES, respectively. Similar or slightly lower rates of stent thrombosis were seen for most lesion types, except higher rates for small vessels for BMS (5.2%) and true bifurcation for DES (3.3%). Rates of target lesion revascularization (TLR) were 7.5% for BMS and 19.6% for DES at 6-12 months. At 2-years TLR remained lower than DES. When the combined group was compared to registry data alone, similar values were seen. CONCLUSIONS Rates of mortality, myocardial infarction (MI), and stent thrombosis were similar in patients receiving BMS or DES, while TLR rates were lower in DES patients.
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Affiliation(s)
- Nirat Beohar
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA.
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22
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Garg S, Serruys PW. Coronary Stents. J Am Coll Cardiol 2010; 56:S1-42. [PMID: 20797502 DOI: 10.1016/j.jacc.2010.06.007] [Citation(s) in RCA: 307] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 06/01/2010] [Accepted: 06/15/2010] [Indexed: 01/07/2023]
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Brilakis ES, Lasala JM, Cox DA, Berger PB, Bowman TS, Starzyk RM, Dawkins KD. Outcomes After Implantation of the TAXUS Paclitaxel-Eluting Stent in Saphenous Vein Graft Lesions. JACC Cardiovasc Interv 2010; 3:742-50. [DOI: 10.1016/j.jcin.2010.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 03/23/2010] [Accepted: 04/17/2010] [Indexed: 10/19/2022]
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Meier P, Brilakis ES, Corti R, Knapp G, Shishehbor MH, Gurm HS. Drug-eluting versus bare-metal stent for treatment of saphenous vein grafts: a meta-analysis. PLoS One 2010; 5:e11040. [PMID: 20548794 PMCID: PMC2883580 DOI: 10.1371/journal.pone.0011040] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 05/21/2010] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Saphenous vein grafts develop an aggressive atherosclerotic process and the efficacy of drug eluting stents (DES) in treating saphenous vein graft (SVG) lesions has not been convincingly demonstrated. The aim of this study was to review and analyze the current literature for controlled studies comparing DES versus bare metal stents (BMS) for treatment of SVG stenoses. METHODOLOGY/PRINCIPAL FINDINGS We searched several scientific databases and conference proceedings up to March 15, 2010 for controlled studies comparing target vessel revascularization (TVR) between DES and BMS. Summary odds ratios (OR) for the primary endpoint TVR and secondary endpoints infarction, stent thrombosis and death were calculated using random-effect models. A total of 29 studies (3 randomized controlled trials RCT) involving 7549 (202 in RCT) patients were included. The need for target vessel revascularization in the DES group tended to be lower compared to BMS for the 3 RCT (OR 0.50 [0.24-1.00]; p = 0.051) and for observational studies (0.62 [0.49-0.79]; p<0.001). There was no significant difference in the risk for myocardial infarction in the RCT (OR 1.25 [0.22-6.99]; p = 0.250) but a lower risk for DES based on the observational studies 0.68 [0.49-0.95]; p = 0.023. The risk for stent thrombosis was found to be non-different in the RCT (OR 0.78 [0.03-21.73], p = 0.885) while it was in favor of DES in the observational studies (0.58 [0.38 - 0.84]; p<0.001). The mortality was not significantly different between DES and BMS in the RCT's (OR 2.22 [0.17 - 29.50]; p = 0.546) while the observation studies showed a decreased mortality in the DES group (0.69 [0.55-0.85]; p<0.001). CONCLUSION DES may decrease TVR rate in treatment of SVG stenoses. No differences in reinfarction rate, stent thrombosis or mortality was found between the DES and BMS groups in the RCT's while the observational data showed lower risk for myocardial infarction, stent thrombosis and death in the DES group. This may be a result of patient selection bias in the observational studies or represent a true finding that was not the detected in the RCT analysis due to limited statistical power.
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Affiliation(s)
- Pascal Meier
- University of Michigan Medical Center, Ann Arbor, Michigan, United States of America
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States of America
| | - Emmanouil S. Brilakis
- Division of Cardiovascular Diseases, Veterans Affairs North Texas Healthcare System, Dallas, Texas, United States of America
| | - Roberto Corti
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Guido Knapp
- Department of Statistics, TU Dortmund University, Dortmund, Germany
| | - Mehdi H. Shishehbor
- Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, United States of America
| | - Hitinder S. Gurm
- University of Michigan Medical Center, Ann Arbor, Michigan, United States of America
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, United States of America
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25
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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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Sanchez-Recalde A, Jiménez Valero S, Moreno R, Barreales L, Lozano Í, Galeote G, Martín Reyes R, Calvo L, Lopez-Sendon J. Safety and efficacy of drug-eluting stents versus bare-metal stents in saphenous vein grafts lesions: a meta-analysis. EUROINTERVENTION 2010. [DOI: 10.4244/eijv6i1a22] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Goswami NJ, Gaffigan M, Berrio G, Plessa AL, Pfeiffer AM, Markwell SJ, Mishkel GJ. Long-term outcomes of drug-eluting stents versus bare-metal stents in saphenous vein graft disease: results from the Prairie "Real World" Stent Registry. Catheter Cardiovasc Interv 2010; 75:93-100. [PMID: 19787803 DOI: 10.1002/ccd.22194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES This study was designed to compare long-term clinical outcomes of drug-eluting 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 = 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.
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Affiliation(s)
- Nilesh J Goswami
- Prairie Heart Institute at St. John's Hospital, Springfield, IL 62794-9420, USA.
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28
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Effectiveness and safety of drug-eluting stents in vein grafts: a meta-analysis. Am Heart J 2010; 159:159-169.e4. [PMID: 20152212 DOI: 10.1016/j.ahj.2009.11.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Accepted: 11/12/2009] [Indexed: 11/21/2022]
Abstract
BACKGROUND The use of drug-eluting stents (DES) in degenerative vein grafts is currently an off-label indication. Recent studies have had conflicting results regarding the effectiveness and safety of this practice. The objective of this meta-analysis was to compare DES to bare-metal stents for the treatment of vein graft stenosis. METHODS PubMed and the Cochrane clinical trials database were systematically searched to identify all randomized controlled trials (RCTs) and observational studies examining DES for vein graft stenosis published in English between 2003 and 2009. Inclusion criteria included follow-up duration > or =6 months. Data were stratified by study design and pooled using random effects models. RESULTS Twenty studies were found to meet our inclusion criteria. Eighteen studies were observational and 2 were RCTs. In observational studies, DES were associated with a reduction in major adverse cardiac events (MACE) (odds ratio [OR] 0.50, 95% CI 0.35-0.72), death (OR 0.69, 95% CI 0.53-0.91), target vessel revascularization (TVR) (OR 0.54, 95% CI 0.37-0.79), and target lesion revascularization (TLR) (OR 0.54, 95% CI 0.37-0.78). The incidence of myocardial infarction was similar between groups. In the RCTs, pooled results were inconclusive because of small sample sizes. CONCLUSIONS Although data from observational studies suggest that the use of DES for vein graft stenosis has favorable effects on MACE, death, TVR, and TLR, these data should be interpreted with caution due to their observational nature. Corresponding RCT data are inconclusive. There remains a need for large multicenter RCTs to address the effectiveness and safety of DES for vein graft stenosis.
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Brodie BR, Wilson H, Stuckey T, Nussbaum M, Laurent S, Bradshaw B, Humphrey A, Metzger C, Hermiller J, Krainin F, Juk S, Cheek B, Duffy P, Simonton CA. Outcomes with drug-eluting versus bare-metal stents in saphenous vein graft intervention results from the STENT (strategic transcatheter evaluation of new therapies) group. JACC Cardiovasc Interv 2010; 2:1105-12. [PMID: 19926052 DOI: 10.1016/j.jcin.2009.08.020] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Accepted: 08/24/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study compares outcomes of drug-eluting stents (DES) versus bare-metal stents (BMS) in patients undergoing saphenous vein graft (SVG) intervention. BACKGROUND The safety and efficacy of DES in patients undergoing SVG intervention is controversial. METHODS The STENT (Strategic Transcatheter Evaluation of New Therapies) registry is a multicenter U.S. registry evaluating outcomes with DES. Our study population includes patients undergoing PCI of SVG lesions with DES (n = 785) or BMS (n = 343) who completed 9-month or 2-year follow-up. Outcomes were adjusted with propensity analyses. RESULTS The DES patients had fewer emergent procedures but had smaller vessels and longer lesions. The DES patients had less death or myocardial infarction at 9 months (hazard ratio [HR]: 0.52, 95% confidence interval [CI]: 0.33 to 0.83, p = 0.006) and less death at 2 years (HR: 0.60, 95% CI: 0.36 to 0.98, p = 0.041). Target vessel revascularization (TVR) was less with DES at 9 months (7.2% vs. 10.0%, HR: 0.36, 95% CI: 0.22 to 0.61, p < 0.001) but was no different by 2 years (18.3% vs. 16.9%, p = 0.86), although adjusted TVR rates were lower (HR: 0.60, 95% CI: 0.40 to 0.90, p = 0.014). The DES reduced TVR at 9 months in SVG lesions with diameter <3.5 mm (8.0% vs. 17.2%, p = 0.013) but not >or=3.5 mm (6.0% vs. 6.6%, p = 0.74). CONCLUSIONS Treatment of SVG lesions with DES vs. BMS is effective in reducing TVR at 9 months, although most of this advantage is lost at 2 years. The DES seem safe with less death or myocardial infarction, although selection bias might have affected these results. Our data suggest that DES might have short-term advantages over BMS in SVG lesions with diameter <3.5 mm.
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Affiliation(s)
- Bruce R Brodie
- The LeBauer Cardiovascular Research Foundation, Greensboro, North Carolina 27408, USA.
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30
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Brilakis E, Saeed B, Banerjee S. Drug-eluting stents in saphenous vein graft interventions: a systematic review. EUROINTERVENTION 2010; 5:722-30. [DOI: 10.4244/eijv5i6a119] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Shishehbor MH, Hawi R, Singh IM, Tuzcu EM, Bhatt DL, Ellis SG, Kapadia SR. Drug-eluting versus bare-metal stents for treating saphenous vein grafts. Am Heart J 2009; 158:637-43. [PMID: 19781425 DOI: 10.1016/j.ahj.2009.08.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2009] [Accepted: 08/06/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND Current data show conflicting results regarding safety and efficacy of drug-eluting stents (DES) versus bare-metal stents (BMS) for treating saphenous vein grafts (SVG). Our objective was to compare DES with BMS for SVG intervention. METHODS Patients undergoing stenting with DES or BMS to SVG from January 2000 to June 2007 were included. To eliminate any unobserved bias regarding stent selection, the BMS cohort was divided into pre- and post-2003 when DES became available. Adjusted Cox analysis compared DES with pre- and post-2003 BMS patients. The primary end point was a composite of all-cause mortality, myocardial infarction, or target lesion revascularization. RESULTS Of the total 566 patients, 217 (38%) received DES, 110 (20%) received BMS post-2003, and 239 (42%) received BMS pre-2003. Median follow-up was 2.9 years (interquartile range 1.4-4.9 years). There was a trend toward lower primary end point with DES compared to post-2003 BMS (91 events, adjusted hazard ratio 0.61, 95% CI 0.35-1.07, P = .08). However, despite 179 events, DES use was not associated with lower primary end point compared with pre-2003 BMS (adjusted hazard ratio 0.61, 95% CI 0.28-1.35, P = .23). CONCLUSIONS Although DES showed a trend toward a lower primary end point when compared with BMS post-2003, this association was no longer present when DES was compared to pre-2003 BMS. These results are consistent with the preponderance of available data and indicate that unobserved bias in observational registries may explain the reported benefit of DES over BMS for treating SVG.
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Affiliation(s)
- Mehdi H Shishehbor
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH 44114, USA
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Lasala JM, Cox DA, Lewis SJ, Tadros PN, Haas RC, Schweiger MJ, Chhabra A, Untereker WJ, Starzyk RM, Mascioli SR, Dawkins KD, Baim DS. Expanded use of the TAXUS Express Stent: two-year safety insights from the 7,500 patient ARRIVE Registry programme. EUROINTERVENTION 2009; 5:67-77. [PMID: 19577985 DOI: 10.4244/eijv5i1a11] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We report 2-year outcomes in a large unselected drug-eluting stent population (N=7,492) in the TAXUS Express2 ARRIVE post-market surveillance programme (101 U.S. sites). METHODS AND RESULTS No specific inclusion/exclusion criteria were mandated; patients enrolled at procedure initiation. Two-year follow-up was 94%, with independent adjudication of major cardiac events, monitoring of patients with cardiac events and an additional 10-20% sample by site. Most ARRIVE cases (64%, n=4,794) typified expanded use based on patient/lesion characteristics outside the simple use (single vessel/stent) pivotal trial populations. These expanded use patients had higher 2-year rates than simple use patients for mortality (7.8% vs. 4.2%, P<0.001), myocardial infarction (MI, 3.9% vs. 2.2%, P<0.001), target lesion revascularisation (TLR, 9.2% vs. 5.4%, P<0.001), and stent thrombosis (3.3% vs. 1.4%, P<0.001). Among subgroups with renal disease, chronic total occlusion (CTO), lesion >28 mm, reference vessel diameter (RVD) <2.5 mm, multivessel stenting, acute MI, bifurcation, vein graft, or in-stent restenosis, TLR ranged from 3.8% to 8.9% in year one, and from 1.3% to 6.0% during year two. CONCLUSIONS Mortality and stent-related events were higher in expanded use than simple use patients in the pivotal trials. ARRIVE provides a detailed estimate of procedural and 2-year outcomes in such real-world patients.
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Affiliation(s)
- John M Lasala
- Washington University School of Medicine, St. Louis, MO 63110, USA.
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Rutigliano D, Vacca M, Pestrichella V, Contegiacomo G. Use of Proxis for percutaneous coronary intervention in patients with totally occluded saphenous vein grafts: an alternative approach. J Cardiovasc Med (Hagerstown) 2009; 10:869-74. [PMID: 19531960 DOI: 10.2459/jcm.0b013e32832e26f8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Surgery is a common approach for diffuse coronary artery disease. Saphenous vein grafts are frequently used but are characterized by degeneration and high incidence of failure at 10 years. Percutaneous coronary intervention is preferred over re-operation because of age, comorbidity and the diffusion of coronary artery disease. With the saphenous vein graft occluded, percutaneous coronary intervention of native vessels and medical therapy alone are commonly suggested. We report three cases of patients with totally occluded saphenous vein grafts with suitable characteristics for treatment with Proxis, a device able to induce a proximal protection of the target vessel, minimizing the risk of distal embolization as well as the quantity of contrast required. In all patients there were no complications or cardiac enzyme elevations, and each case resulted in complete revascularization immediately postprocedure. Patients were asymptomatic at 6-month follow-up and procedural success was shown in two patients that consented to follow-up angiography. We conclude that Proxis could be a valuable tool for percutaneous coronary intervention of totally occluded saphenous vein grafts in patients who are poor candidates for percutaneous coronary intervention of native vessel; nevertheless these observations should be confirmed by a long-term follow-up controlled study.
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Affiliation(s)
- David Rutigliano
- Unità Operativa di Emodinamica, Casa di Cura Santa Maria, Bari, Italy.
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Brilakis ES, Lichtenwalter C, de Lemos JA, Roesle M, Obel O, Haagen D, Saeed B, Gadiparthi C, Bissett JK, Sachdeva R, Voudris VV, Karyofillis P, Kar B, Rossen J, Fasseas P, Berger P, Banerjee S. A Randomized Controlled Trial of a Paclitaxel-Eluting Stent Versus a Similar Bare-Metal Stent in Saphenous Vein Graft Lesions. J Am Coll Cardiol 2009; 53:919-28. [DOI: 10.1016/j.jacc.2008.11.029] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Revised: 10/30/2008] [Accepted: 11/03/2008] [Indexed: 10/21/2022]
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Jim MH, Ho HH, Ko RLY, Yiu KH, Siu CW, Lau CP, Chow WH. Paclitaxel-eluting stent long-term outcomes in percutaneous saphenous vein graft interventions (PELOPS) study. Am J Cardiol 2009; 103:199-202. [PMID: 19121436 DOI: 10.1016/j.amjcard.2008.08.057] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Revised: 08/31/2008] [Accepted: 08/31/2008] [Indexed: 11/25/2022]
Abstract
This study examined the 1-year clinical and angiographic follow-up results of implantation of paclitaxel-eluting stents (PES) in aortocoronary saphenous vein graft (SVG) lesions. Sixty-eight consecutive patients with 90 nonoccluded SVG lesions were treated with PES (Taxus), size ranging from 2.25 to 4.5 mm. Angiographic follow-up was performed on 63 patients (93%) and 83 lesions (92%) at 12 months; major adverse cardiac event (MACE) was recorded in all patients at 1 year. The mean age of patients was 71+/-8 years with predominance of men (75%); the mean graft age was 13+/-4 years. Glycoprotein IIb/ IIIa inhibitors were given in 21 patients (31%); embolic protection devices were used in 54 lesions (60%). On average, patients received 1.4 stents per lesion with a stent size of 3.4+/-0.6 mm and a length of 35.8+/-27.0 mm. Angiographic follow-up revealed a late loss of 0.36+/-0.66 mm with an in-segment binary restenosis rate of 7%. The in-hospital MACE was 7%, which was solely contributed by 5 patients with postprocedure non-Q myocardial infarction; the 1-year MACE was 15%, accounted by 1 noncardiac death and 9 patients with target vessel revascularization. Peripheral vascular disease and the use of glycoprotein IIb/ IIIa inhibitors were the independent predictors of MACE at 1 year. In conclusion, implantation of PES to treat degenerative aortocoronary SVG lesions is safe and associated with low late loss, angiographic restenosis, and MACE at 1-year follow-up.
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Lozano Í, García-Camarero T, Carrillo P, Baz JA, de la Torre JM, López-Palop R, Pinar E, Salvatella N, Avanzas P, Valdés M. Comparación de los stents liberadores de fármaco y los convencionales en puentes de safena. Resultados inmediatos y a largo plazo. Rev Esp Cardiol 2009. [DOI: 10.1016/s0300-8932(09)70019-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Brilakis ES, Berger PB. Should bare metal or drug-eluting stents be used during PCI of saphenous vein graft lesions: Waiting for Godot? Catheter Cardiovasc Interv 2008; 72:815-8. [DOI: 10.1002/ccd.21657] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Satler LF. Do we still need distal protection in the treatment of SVG disease? Catheter Cardiovasc Interv 2008; 72:804-5. [DOI: 10.1002/ccd.21864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Okabe T, Lindsay J, Torguson R, Steinberg DH, Roy P, Slottow TLP, Kaneshige K, Xue Z, Satler LF, Kent KM, Pichard AD, Waksman R. Can direct stenting in selected saphenous vein graft lesions be considered an alternative to percutaneous intervention with a distal protection device? Catheter Cardiovasc Interv 2008; 72:799-803. [PMID: 19006243 DOI: 10.1002/ccd.21678] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Teruo Okabe
- Washington Hospital Center, Washington, DC 20010, USA
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Drug-eluting stents versus bare metal stents for narrowing in saphenous vein grafts. Am J Cardiol 2008; 102:530-4. [PMID: 18721507 DOI: 10.1016/j.amjcard.2008.04.041] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Revised: 04/23/2008] [Accepted: 04/23/2008] [Indexed: 11/20/2022]
Abstract
Conflicting data exist regarding an advantage of drug-eluting stents (DES) over bare metal stents (BMS) in catheter-based treatment of saphenous vein graft (SVG) stenoses. This study was undertaken to compare the efficacy of these modalities in that lesion subset. The DES group consisted of 138 cases with 183 lesions (sirolimus-eluting stents, n = 117; paclitaxel-eluting stents, n = 66) and the BMS group consisted of 344 cases with 478 lesions that were followed to 1 year. We examined a composite end point that comprised death, Q-wave myocardial infarction, and target lesion revascularization. More BMS were deployed per patient (p <0.001) and the diameters of BMS deployed was significantly greater (p <0.001). Peak postprocedure values of creatine kinase-MB (p = 0.003) and troponin I (p = 0.05) were higher in BMS. At 1 year there was no significant superiority of DES over BMS with regard to hard end points (death and Q-wave myocardial infarction). In conclusion, this study indicates that both DES and BMS for SVG disease provide acceptably safe and efficacious results, but unlike the case in native coronary arteries, DES use does not reduce the frequency of the need for repeat revascularization.
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Gioia G, Benassi A, Mohendra R, Chowdhury K, Masood I, Matthai W. Lack of clinical long-term benefit with the use of a drug eluting stent compared to use of a bare metal stent in saphenous vein grafts. Catheter Cardiovasc Interv 2008; 72:13-20. [DOI: 10.1002/ccd.21599] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Assali A, Raz Y, Vaknin-Assa H, Ben-Dor I, Brosh D, Teplitsky I, Fuchs S, Kornowski R. Beneficial 2-years results of drug-eluting stents in saphenous vein graft lesions. EUROINTERVENTION 2008; 4:108-14. [DOI: 10.4244/eijv4i1a18] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Mamas M, Fraser D, Fath-Ordoubadi F. The role of thrombectomy and distal protection devices during percutaneous coronary interventions. EUROINTERVENTION 2008; 4:115-23. [DOI: 10.4244/eijv4i1a19] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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BRILAKIS EMMANOUILS, SAEED BILAL, BANERJEE SUBHASH. Use of Drug-Eluting Stents in Saphenous Vein Aortocoronary Bypass Graft Lesions: A Critical Appraisal. J Interv Cardiol 2008; 21:151-7. [DOI: 10.1111/j.1540-8183.2007.00341.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Nikolsky E, Stone GW. Utility of drug-eluting stents in complex lesions and high-risk patients. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2008; 9:11-28. [PMID: 17378972 DOI: 10.1007/s11936-007-0047-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Drug-eluting stents represent a breakthrough technology designed to deliver high concentrations of a bioactive agent locally to an atherosclerotic lesion, thereby minimizing systemic side effects of the drug. The safety and efficacy of drug-eluting stents have clearly been demonstrated in noncomplex lesions. This article presents an evidence-based analysis of the current experience with CYPHER sirolimus-eluting stents (Cordis Corp., Miami Lakes, FL) and TAXUS paclitaxel-eluting stents (Boston Scientific, Natick, MA) in a broad spectrum of high-risk and/or complex subsets of patients and lesions, including those with diabetes mellitus, multivessel disease, diffuse disease, very small vessels, lesions in saphenous vein grafts, chronic total occlusions, in-stent restenosis, ostial and bifurcation lesions, unprotected left main disease, and acute myocardial infarction. Emerging data in several of these subsets suggest that drug-eluting stents are safe and effective, and their use may currently be recommended, whereas in other groups of patients and lesions the efficacy and/or safety of drug-eluting stents remains to be determined, thus warranting caution. It is anticipated that penetration of drug-eluting stents will continue to increase, and fewer patients will require surgical revascularization to achieve sustained event-free survival.
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Affiliation(s)
- Eugenia Nikolsky
- Columbia University Medical Center, Herbert Irving Pavilion, 5th Floor, 161 Fort Washington Avenue, New York, NY 10032, USA
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Vermeersch P, Agostoni P, Verheye S, Van den Heuvel P, Convens C, Van den Branden F, Van Langenhove G. Reply. J Am Coll Cardiol 2008. [DOI: 10.1016/j.jacc.2007.11.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bansal D, Sachdeva R, Mehta JL. Percutaneous Intervention in Saphenous Vein Bypass Graft Disease. J Am Coll Cardiol 2008; 51:970-1; author reply 971-2. [DOI: 10.1016/j.jacc.2007.08.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Accepted: 08/16/2007] [Indexed: 11/25/2022]
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Ramana RK, Ronan A, Cohoon K, Homan D, Sutherland J, Steen L, Liu J, Loeb H, Lewis BE. Long-term clinical outcomes of real-world experience using sirolimus-eluting stents in saphenous vein graft disease. Catheter Cardiovasc Interv 2008; 71:886-93. [DOI: 10.1002/ccd.21552] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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