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Wańha W, Mielczarek M, Roleder T, Ładziński S, Milewski M, Gilis-Malinowska N, Chmielecki M, Ciećwierz D, Bachorski W, Kunik P, Trznadel A, Męcka K, Genc A, Januszek R, Pączek P, Dziewierz A, Bartuś S, Gruchała M, Smolka G, Dudek D, Navarese EP, Ochała A, Jaguszewski M, Wojakowski W. New-generation drug eluting stent vs. bare metal stent in saphenous vein graft - 1 year outcomes by a propensity score ascertainment (SVG Baltic Registry). Int J Cardiol 2019; 292:56-61. [PMID: 31003797 DOI: 10.1016/j.ijcard.2019.04.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 03/16/2019] [Accepted: 04/08/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Data regarding the efficacy of the percutaneous coronary intervention (PCI) with new-designed drug-eluting stent (new-DES) vs. bare metal stent (BMS) of saphenous vein grafts (SVG) stenosis is scarce. The primary objective was to compare one-year clinical outcomes of PCI in stenosis of SVG using new-DES vs. BMS in a real-world population. METHODS AND RESULTS We carried out a multi-center registry comparing new-DES with BMS in all consecutive patients undergoing PCI of SVG. The primary composite endpoint was major adverse cardiac and cerebrovascular events (MACCE) at 1 year. This observation included 792 consecutive patients (mean age 69 ± 8.9y), treated with either new-DES (n = 379, 47.9%) or BMS (n = 413, 52.1%). Among patients treated with new-DES compared with BMS, there was a lower risk of MACCE (21.4% vs. 28.3%, HR = 0.69, 95% CI 0.50-0.95, p = 0.025) as well as myocardial infarction (MI) (6.3% vs. 12.1%; HR 0.49, 95% CI 0.30-0.82, p = 0.005) at 1 year. After propensity score adjustment, the similar, significant reduction in MACCE and MI was observed in favor of new-DES (HR 0.66, 95% CI 0.46-0.96, p = 0.030; and HR 0.53, 95% CI 0.31-0.92, p = 0.020, respectively). CONCLUSION In patients undergoing PCI of SVG, the use of new-DES is associated with a reduced 1-year rate of MACCE and MI compared to BMS.
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Affiliation(s)
- Wojciech Wańha
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland; SIRIO MEDICINE research network, Italy.
| | | | - Tomasz Roleder
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Szymon Ładziński
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Marek Milewski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Michał Chmielecki
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Dariusz Ciećwierz
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Witold Bachorski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Piotr Kunik
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Agata Trznadel
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Klaudia Męcka
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Alicja Genc
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Rafał Januszek
- Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Piotr Pączek
- Department of Cardiology, Public Clinical Hospital, Sosnowiec, Poland
| | - Artur Dziewierz
- Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Stanisław Bartuś
- Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Marcin Gruchała
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Grzegorz Smolka
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Dariusz Dudek
- Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Eliano Pio Navarese
- Cardiovascular Institute, Nicolaus Copernicus University, Bydgoszcz, Poland; Interventional Cardiology and Cardiovascular Medicine Research, Mater Dei Hospital, Bari, Italy; Department of Cardiovascular Medicine, University of Alberta, Edmonton, Canada; SIRIO MEDICINE research network, Italy
| | - Andrzej Ochała
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Miłosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
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Gao J, Liu Y, Li YM. Review of risk factors, treatment, and prevention of saphenous vein graft disease after coronary artery bypass grafting. J Int Med Res 2018; 46:4907-4919. [PMID: 30178686 PMCID: PMC6300967 DOI: 10.1177/0300060518792445] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Saphenous vein graft disease (SVGD) is a type of vascular disease that may develop after coronary artery bypass grafting (CABG). SVGD seriously affects the short-term and long-term effects of CABG and increases the incidence of major adverse cardiovascular events. It is very important to identify patients at greatest risk and carry out prevention and treatment measures to determine the risk factors for SVGD. Many factors contribute to SVGD when the vein is grafted into an arterial environment, such as surgery-related factors, smoking, diabetes mellitus, hyperlipidemia, and others. In this review, we discuss the risk factors for SVGD, current surgical and pharmacologic therapies with which to manage SVGD, and the prevention of SVGD.
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Affiliation(s)
- Jing Gao
- 1 Logistics University of Chinese People's Armed Police Forces, Dongli District, Tianjin, P. R. China.,2 Cardiovascular Institute, Tianjin Chest Hospital, Jinnan District, Tianjin, P. R. China
| | - Yin Liu
- 3 Department of Cardiology, Tianjin Chest Hospital, Jinnan District, Tianjin, P. R. China
| | - Yu-Ming Li
- 1 Logistics University of Chinese People's Armed Police Forces, Dongli District, Tianjin, P. R. China
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3
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Elgendy IY, Mahmoud AN, Brilakis ES, Bavry AA. Drug-eluting stents versus bare metal stents for saphenous vein graft revascularisation: a meta-analysis of randomised trials. EUROINTERVENTION 2018; 14:215-223. [DOI: 10.4244/eij-d-17-00839] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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4
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Sharma D, Kotowycz MA, Sharma V, Choudhury A, Chan W, Freixa X, Džavík V, Overgaard CB. Characteristics and outcomes of patients undergoing percutaneous coronary intervention within 1 year of coronary artery bypass graft surgery. Catheter Cardiovasc Interv 2017; 90:186-193. [DOI: 10.1002/ccd.26853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 09/24/2016] [Accepted: 10/12/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Divyesh Sharma
- Peter Munk Cardiac Centre; Toronto General Hospital, University Health Network; Toronto Canada
| | - Mark A. Kotowycz
- Peter Munk Cardiac Centre; Toronto General Hospital, University Health Network; Toronto Canada
| | - Vinoda Sharma
- Peter Munk Cardiac Centre; Toronto General Hospital, University Health Network; Toronto Canada
| | - Anirban Choudhury
- Peter Munk Cardiac Centre; Toronto General Hospital, University Health Network; Toronto Canada
| | - William Chan
- Peter Munk Cardiac Centre; Toronto General Hospital, University Health Network; Toronto Canada
| | - Xavier Freixa
- Peter Munk Cardiac Centre; Toronto General Hospital, University Health Network; Toronto Canada
| | - Vladimír Džavík
- Peter Munk Cardiac Centre; Toronto General Hospital, University Health Network; Toronto Canada
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Pendyala LK, Loh JP, Kitabata H, Minha S, Torguson R, Chen F, Satler LF, Suddath WO, Pichard AD, Waksman R. The impact of diabetes mellitus on long-term clinical outcomes after percutaneous coronary saphenous vein graft interventions in the drug-eluting stent era. J Interv Cardiol 2016; 27:391-8. [PMID: 25059286 DOI: 10.1111/joic.12136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES We aimed to compare early and late clinical outcomes in diabetic and nondiabetic patients who underwent saphenous vein graft (SVG) percutaneous coronary interventions (PCI) with the use of drug-eluting stents (DES). BACKGROUND Patients with diabetes mellitus are shown to have less favorable outcomes after SVG intervention with the use of bare metal stents. In the DES era, the impact of diabetes mellitus on restenosis and clinical outcomes post-SVG intervention is not clearly defined. METHODS From our institutional PCI registry database, we retrospectively analyzed 477 consecutive patients with prior coronary artery bypass graft surgery undergoing SVG PCI with the implantation of DES stratified by the presence or absence of diabetes mellitus. The primary end-point was 1-year major adverse cardiac event (MACE) rate, defined as death, Q wave myocardial infarction, and target lesion revascularization. RESULTS Baseline clinical characteristics, including mean graft age (120 ± 77 vs. 131 ± 86 months, P = 0.14), were similar between groups, save for a higher prevalence of systemic hypertension and chronic renal insufficiency, and higher body mass index in the diabetic group. Among the 604 SVG lesions treated with DES, the angiographic and procedural characteristics were well matched between groups except for the higher rate of distal protection device use (32% vs. 29%, P = 0.007) in the diabetic group. The rates of 1-year MACE (21% vs. 15%, P = 0.12) and all-cause mortality (7.6% vs. 6.7%, P = 0.86) were similar between groups. After adjustment for the relevant clinical co-variables, diabetic status was not associated with the composite end-point. CONCLUSION In conclusion, DES, when used for the treatment of vein graft lesions, equate the short- and long-term outcomes between diabetic and nondiabetic patients, suggesting that DES should be considered the default stent in diabetic populations undergoing PCI for the treatment of SVG lesions.
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Affiliation(s)
- Lakshmana K Pendyala
- Division of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
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Sadr-Ameli M, Mousavi H, Heidarali M, Maadani M, Ghelich Y, Ghadrdoost B. Early and midterm major adverse cardiac events in patient with saphenous vein graft using direct stenting or embolic protection device stenting. Res Cardiovasc Med 2014; 3:e13012. [PMID: 25478526 PMCID: PMC4253743 DOI: 10.5812/cardiovascmed.13012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 08/24/2013] [Accepted: 11/15/2013] [Indexed: 11/16/2022] Open
Abstract
Background: The treatment of an occluded saphenous vein graft (SVG) with percutaneous coronary intervention may encounter major adverse cardiac events (MACE). MACE rates have been reduced significantly by using the embolic protection device (EPD). Objectives: The aim of this study was to clarify the risks and the benefits of embolic protection devices. Patients and Methods: In a prospective, non-randomized observational study, patients aged 33 to 85 years old who underwent elective percutaneous coronary intervention due to SVG stenosis at our tertiary care center were enrolled between 2009 and 2011. The incidence rates of adverse events, including MACE, were obtained during the patients’ hospitalization and at 30-day and 6-month follow-up. MACE included death, Q-wave and non-Q-wave myocardial infarction, in-stent thrombosis, target lesion revascularization, and target vessel revascularization. Results: From 150 patients enrolled to the study, 128 (85.3%) patients underwent direct stenting and the rest underwent the EPD procedure. In-hospital MACE occurred in 17.2% of the patients in the direct stenting group versus only 9.1% in the EPD group (P = 0.530). MACE incidence was gradually increased at one and 6-month follow-up periods in the direct stenting group (19.5% and 21.9%, respectively), and remained unchanged in the EPD group (9.1% at six-month follow-up). Multivariate logistic regression model showed that the stenting procedure type could not predict early and midterm MACE with the presence of baseline characteristics as cofounders. Conclusions: Despite the considerable lower early and midterm MACE rates, numerically following the EPD procedure compared to direct stenting, the difference in the MACE rates between the two groups was not significant.
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Affiliation(s)
- Mohammadali Sadr-Ameli
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Hossein Mousavi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Mona Heidarali
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Mohsen Maadani
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Mohsen Madaani, Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Vali-e-Asr St., Niayesh Blvd, Tehran, IR Iran. Tel: +98-2123923017, Fax: +98-2122663217, E-mail:
| | - Yones Ghelich
- Department of Intervention, 502 Military Hospital, Tehran, IR Iran
| | - Behshid Ghadrdoost
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
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Head-to-head comparison of sirolimus-eluting stents versus paclitaxel-eluting stents in patients undergoing percutaneous coronary intervention: a meta-analysis of 76 studies. PLoS One 2014; 9:e97934. [PMID: 24844284 PMCID: PMC4028235 DOI: 10.1371/journal.pone.0097934] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 04/26/2014] [Indexed: 11/19/2022] Open
Abstract
Background The relative short-, long- and overall-term efficacy and safety of sirolimus-eluting stents (SES, Cypher) compared with paclitaxel-eluting stents (PES, Taxus) in large head-to-head comparisons still remain to be defined. Methods We searched Pubmed, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) for articles comparing outcomes of interest between SES and PES without language restriction. Short- (≤1 year), long- (>1 year), and overall-term (the longest follow-up of each study) outcomes were evaluated. The primary endpoint was target lesion revascularization (TLR). Other outcomes of interest were target vessel revascularization (TVR), myocardial infarction, all-cause death, cardiac death, stent thrombosis, major adverse cardiac events (MACEs), restenosis and late lumen loss. Results Seventy-six studies including more than 15000 patients in randomized controlled trials and over 70000 patients in adjusted observational studies were included. At overall-term follow-up, SES significantly reduced TLR (relative risk [RR]: 0.61; 95% confidence interval [CI]: 0.49–0.76), TVR (RR: 0.67; 95% CI: 0.54–0.83), MACE (RR: 0.79; 95% CI: 0.72–0.87), myocardial infarction (RR: 0.85; 95% CI: 0.73–0.99), in-segment restenosis (RR: 0.50; 95% CI: 0.38–0.65), and in-segment late lumen loss (weighted mean difference [WMD]: −0.19; 95% CI: −0.24–−0.14) in randomized controlled trials compared with PES. In addition, lower rates of death (RR: 0.91; 95% CI: 0.83–1.00), any stent thrombosis (RR: 0.62; 95% CI: 0.45–0.86), definite stent thrombosis (RR: 0.59; 95% CI: 0.45–0.77) were found in patients receiving SES in adjusted observational studies. Largely similar results were found at short- and long-term follow-up, and in patients with diabetes, acute myocardial infarction or long lesions. Conclusions SES significantly reduced the short-, long- and overall-term risk of TLR/TVR, MACE, and restenosis, and overall-term risk of myocardial infarction in randomized controlled trials, as compared with PES. Lower rates of death and stent thrombosis were also observed in observational studies in SES-treated patients.
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Hoffman DM, Tranbaugh RF. Interventions for coronary artery disease (surgery vs angioplasty) in diabetic patients. Endocrinol Metab Clin North Am 2014; 43:59-73. [PMID: 24582092 DOI: 10.1016/j.ecl.2013.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Patients with diabetes develop more widespread and more severe atherosclerotic coronary artery disease than patients without diabetes. Medical management of this coronary disease is inferior to revascularization for more complex or more widespread disease. Revascularization by percutaneous intervention (PCI) for patients with diabetes is associated with high mortality and complication rates. Surgical revascularization by coronary artery bypass grafting, yields superior results to PCI for patients with diabetes and coronary artery disease. Patients with diabetes benefit from the same medical management of their coronary artery disease and secondary risk modification as patients without diabetes.
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Affiliation(s)
- Darryl M Hoffman
- Division of Cardiothoracic Surgery, Beth Israel Medical Center, 317 East 17th Street, 11th Floor, New York, NY 10003, USA.
| | - Robert F Tranbaugh
- Division of Cardiothoracic Surgery, Beth Israel Medical Center, 317 East 17th Street, 11th Floor, New York, NY 10003, USA
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Marmagkiolis K, Grines C, Bilodeau L. Current percutaneous treatment strategies for saphenous vein graft disease. Catheter Cardiovasc Interv 2013; 82:406-13. [PMID: 22777812 DOI: 10.1002/ccd.24554] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 06/30/2012] [Indexed: 12/16/2022]
Abstract
Coronary artery bypass graft surgery remains one of the most widely performed surgical procedures in North America and aortocoronary saphenous vein grafts (SVG) are the most frequently used surgical conduits. SVG disease (SVGD) remains the leading cause of symptomatic coronary artery disease postcoronary artery bypass graft. When optimal medical therapy is ineffective, repeat surgery is associated with higher mortality combined with less favorable clinical and angiographic results, thus percutaneous revascularization on SVG is currently the standard of care for the revascularization of SVGD. Balloon angioplasty, bare metal stents, polytetrafluoroethylene-covered stents, and drug-eluting stents have been extensively investigated for SVG interventions. Multiple recent randomized trials and meta-analyses have confirmed the pathophysiologic and clinical differences between SVGD and coronary artery disease. Decisions such as patient selection, premedication, stent, and protection device characteristics should be carefully considered to achieve optimal procedural and clinical results. Acute coronary syndromes due to SVG involvement, chronic total occlusions, retrograde approaches, and SVG perforation management are newer fields requesting additional research.
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Affiliation(s)
- Kostantinos Marmagkiolis
- William Beaumont Hospital, Royal Oak, Michigan; Montreal Heart Institute, Montreal, Quebec, Canada
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10
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Hoyt JR, Gurm HS. Drug-Eluting Stents Versus Bare Metal Stents in Saphenous Vein Graft Intervention. Interv Cardiol Clin 2013; 2:283-305. [PMID: 28582136 DOI: 10.1016/j.iccl.2012.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Percutaneous coronary intervention (PCI) of saphenous vein graft (SVG) is associated with higher adverse event rates, lower procedural success, and inferior longterm patency rates compared with native vessel PCI. The ability to comply with dual antiplatelet therapy, and whether the patient will need an interruption in dual antiplatelet therapy, should be considered when deciding whether to implant a drug-eluting stent (DES) or bare metal stent (BMS) in an SVG. DES should be used for SVG PCI because they seem to reduce target vessel revascularization. This article reviews the evolution and contemporary evidence regarding use of DES versus BMS in SVG PCI.
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Affiliation(s)
- John R Hoyt
- Division of Cardiovascular Disease, Department of Internal Medicine, University of Michigan Cardiovascular Center, University of Michigan, 1500 East Medical Center Drive, 2381 CVC SPC 5853, Ann Arbor, MI 48109-5853, USA
| | - Hitinder S Gurm
- Division of Cardiovascular Disease, Department of Internal Medicine, University of Michigan Cardiovascular Center, University of Michigan, 1500 East Medical Center Drive, Room 2A394, Ann Arbor, MI 48109-5853, USA.
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11
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Fröbert O, Scherstén F, James SK, Carlsson J, Lagerqvist B. Long-term safety and efficacy of drug-eluting and bare metal stents in saphenous vein grafts. Am Heart J 2012; 164:87-93. [PMID: 22795287 DOI: 10.1016/j.ahj.2012.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Accepted: 04/22/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Long-term safety and efficacy data of drug-eluting stents (DESs) in saphenous vein grafts (SVGs) are lacking. This study sought to compare the clinical outcomes of DES versus bare metal stents (BMS) in SVGs. METHODS We studied all stent implantations in SVGs in Sweden during 74 months between 2005 and 2011 registered in the Swedish Coronary Angiography and Angioplasty Registry. We evaluated outcome in patients who received DES compared with those who received BMS after adjustments for differences in clinical, vessel, and lesion characteristics. RESULTS Mean follow-up time was 3 years and 4 months. A total of 4,576 stents, implanted at 3,063 procedures, were included in the analysis of which 2,499 stents (54.6 %) were BMS and 2,077 (45.4%) were DES. The outcome analysis was based on 190 stent thromboses, 898 restenoses, and 523 deaths. The incidence of stent thrombosis did not differ between groups. When adjusted for baseline characteristics, including a propensity score for receiving DES, the incidence of restenosis was significantly lower with DES as compared with BMS (risk ratio 0.83, 95% CI 0.70-0.97, P = .019). There was a difference in mortality in the crude analysis between DES and BMS, and after multivariable adjustment, this difference remained statistically significant (risk ratio 0.80, CI 0.65-0.99, P = .038). CONCLUSIONS The use of DES compared with BMS in SVGs was associated with a significantly lower adjusted incidence of restenosis and death in this large, national, all-encompassing propensity adjusted observational study.
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Affiliation(s)
- Ole Fröbert
- Department of Cardiology, Örebro University Hospital, Sweden.
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Alam M, Bandeali SJ, Virani SS, Jneid HM, Shahzad SA, Ramanathan KB, Kar B, Kleiman NS, Lakkis N. Clinical outcomes of percutaneous interventions in saphenous vein grafts using drug-eluting stents compared to bare-metal stents: a comprehensive meta-analysisof all randomized clinical trials. Clin Cardiol 2012; 35:291-6. [PMID: 22488047 DOI: 10.1002/clc.21984] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 02/23/2012] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Clinical outcomes of percutaneous coronary intervention (PCI) in patients with saphenous vein grafts (SVGs) remain poor despite the use of drug-eluting stents (DES). There is a disparity in clinical outcomes in SVG PCI based on various registries, and randomized clinical data remain scant. We conducted a meta-analysis of all existing randomized controlled trials (RCTS) comparing bare-metal stents (BMS) and DES in SVGPCIs. HYPOTHESIS PCI in patients with SVG disease using DES may reduce need for repeat revascularization without an excess mortality when compared to BMS. METHODS An aggregate data meta-analysis of clinical outcomes in RCTs comparing PCI with DES vs BMS for SVGs reporting at least 12 months of follow-up was performed. A literature search between Janurary 1, 2003 and September 30, 2011 identified 4 RCTs (812 patients; DES = 416, BMS = 396). Summary odds ratio (OR) and 95% confidence interval (CI) were calculated using the random-effects model. The primary endpoint was all-cause mortality. Secondary outcomes included nonfatal myocardial infarction (MI), repeat revascularization, and major adverse cardiac events (MACE). These outcomes were assessed in a cumulative fashion at 30 days, 18 months, and 36 months. RESULTS There were no intergroup differences in baseline clinical and sociodemographic characteristics. At a median follow-up of 25 months, patients in the DES and BMS group had similar rates of death (OR: 1.63, 95% CI: 0.45-5.92), MI (OR; 0.83, 95% CI: 0.27-2.60), and MACE (OR: 0.58, 95% CI: 0.25-1.32). Patients treated with DES had lower rates of repeat revascularization (OR: 0.40, 95% CI: 0.22-0.75). CONCLUSIONS In this comprehensive meta-analysis of all RCTs comparing clinical outcomes of PCI using DES vs BMS in patients with SVG disease, use of DES was associated with a reduction in rate of repeat revascularization and no difference in rates of all-cause death and MI. Clin. Cardiol. 2012 DOI: 10.1002/clc.21984 Dr. Virani is supported by a Department of Veterans Affairs Health Services Research and Development Service (HSR&D) Career Development Award (CDA-09-028), and has research support from Merck and National Football League Charities (all grants to the institution and not individual). The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. The authors have no other funding, financial relationships, or conflicts of interest to disclose.
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Affiliation(s)
- Mahboob Alam
- Memphis Veterans Affairs Medical Center, Department of Medicine, Section of Cardiology, University of Tennessee Health Sciences Center, Memphis, TN 38104, USA.
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Nauta ST, Van Mieghem NM, Magro M, Deckers JW, Simsek C, Jan Van Geuns R, Van Der Giessen WJ, De Jaegere P, Regar E, Van Domburg RT, Serruys PW. Seven-year safety and efficacy of the unrestricted use of drug-eluting stents in saphenous vein bypass grafts. Catheter Cardiovasc Interv 2011; 79:912-8. [DOI: 10.1002/ccd.23145] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 03/19/2011] [Indexed: 11/10/2022]
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Ziada KM, Abdel-Latif A, Wiisanen ME. Reply. JACC Cardiovasc Interv 2011. [DOI: 10.1016/j.jcin.2011.03.007] [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: 11/26/2022]
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15
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Michishita I. The final answer? For the treatment of saphenous vein graft disease, drug-eluting stents vs. bare-metal stents. Circ J 2011; 75:261-2. [PMID: 21228495 DOI: 10.1253/circj.cj-10-1262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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