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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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2
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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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3
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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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Farhatnia Y, Tan A, Motiwala A, Cousins BG, Seifalian AM. Evolution of covered stents in the contemporary era: clinical application, materials and manufacturing strategies using nanotechnology. Biotechnol Adv 2013; 31:524-42. [DOI: 10.1016/j.biotechadv.2012.12.010] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 12/20/2012] [Accepted: 12/30/2012] [Indexed: 12/24/2022]
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Ybarra LF, Ribeiro HB, Pozetti AH, Campos CA, Esper RB, Lemos PA, Lopes AC, Kalil-Filho R, Ellis SG, Ribeiro EE. Long term follow-up of drug eluting versus bare metal stents in the treatment of saphenous vein graft lesions. Catheter Cardiovasc Interv 2013; 82:E856-63. [DOI: 10.1002/ccd.24781] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 12/07/2012] [Accepted: 12/07/2012] [Indexed: 11/12/2022]
Affiliation(s)
- Luiz F. Ybarra
- Department of Interventional Cardiology; Heart Institute-InCor; University of São Paulo; São Paulo Brazil
| | - Henrique B. Ribeiro
- Department of Interventional Cardiology; Heart Institute-InCor; University of São Paulo; São Paulo Brazil
| | - Antonio H. Pozetti
- Department of Interventional Cardiology; Heart Institute-InCor; University of São Paulo; São Paulo Brazil
| | - Carlos A. Campos
- Department of Interventional Cardiology; Heart Institute-InCor; University of São Paulo; São Paulo Brazil
| | - Rodrigo B. Esper
- Department of Interventional Cardiology; Heart Institute-InCor; University of São Paulo; São Paulo Brazil
| | - Pedro A. Lemos
- Department of Interventional Cardiology; Heart Institute-InCor; University of São Paulo; São Paulo Brazil
| | - Augusto C. Lopes
- Department of Interventional Cardiology; Heart Institute-InCor; University of São Paulo; São Paulo Brazil
| | - Roberto Kalil-Filho
- Department of Interventional Cardiology; Heart Institute-InCor; University of São Paulo; São Paulo Brazil
| | | | - Expedito E. Ribeiro
- Department of Interventional Cardiology; Heart Institute-InCor; University of São Paulo; São Paulo Brazil
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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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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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D'Ascenzo F, Cavallero E, Biondi-Zoccai G, Moretti C, Omedè P, Bollati M, Castagno D, Modena MG, Gaita F, Sheiban I. Use and Misuse of Multivariable Approaches in Interventional Cardiology Studies on Drug-Eluting Stents: A Systematic Review. J Interv Cardiol 2012; 25:611-21. [PMID: 22882654 DOI: 10.1111/j.1540-8183.2012.00753.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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9
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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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Pasceri V, Tarsia G, Niccoli G, Viceconte N, Porto I, Leone AM, Trani C, Speciale G, LIsanti P. Early beneficial effects of drug-eluting stents in vein grafts wane during long term follow-up. Catheter Cardiovasc Interv 2012; 80:1112-7. [DOI: 10.1002/ccd.23468] [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: 05/24/2011] [Revised: 10/23/2011] [Accepted: 10/29/2011] [Indexed: 11/09/2022]
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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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Stone GW, Goldberg S, O'Shaughnessy C, Midei M, Siegel RM, Cristea E, Dangas G, Lansky AJ, Mehran R. 5-Year Follow-Up of Polytetrafluoroethylene-Covered Stents Compared With Bare-Metal Stents in Aortocoronary Saphenous Vein Grafts. JACC Cardiovasc Interv 2011; 4:300-9. [DOI: 10.1016/j.jcin.2010.11.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 11/16/2010] [Indexed: 12/12/2022]
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Brilakis ES, Lichtenwalter C, Abdel-karim ARR, de Lemos JA, Obel O, Addo T, Roesle M, Haagen D, Rangan BV, Saeed B, Bissett JK, Sachdeva R, Voudris VV, Karyofillis P, Kar B, Rossen J, Fasseas P, Berger P, Banerjee S. Continued Benefit From Paclitaxel-Eluting Compared With Bare-Metal Stent Implantation in Saphenous Vein Graft Lesions During Long-Term Follow-Up of the SOS (Stenting of Saphenous Vein Grafts) Trial. JACC Cardiovasc Interv 2011; 4:176-82. [DOI: 10.1016/j.jcin.2010.10.003] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2010] [Revised: 09/24/2010] [Accepted: 10/05/2010] [Indexed: 10/18/2022]
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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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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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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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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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Baldwin DE, Abbott JD, Trost JC, Vlachos HA, Selzer F, Glaser R, Wilensky RL, Slater JN, Doucet S, Naidu SS, Aronow HD, Williams DO. Comparison of drug-eluting and bare metal stents for saphenous vein graft lesions (from the National Heart, Lung, and Blood Institute Dynamic Registry). Am J Cardiol 2010; 106:946-51. [PMID: 20854955 DOI: 10.1016/j.amjcard.2010.05.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 05/14/2010] [Accepted: 05/14/2010] [Indexed: 10/19/2022]
Abstract
The effectiveness and safety of drug-eluting stents (DES) compared with bare-metal stents (BMS) in saphenous vein graft (SVG) disease remains unclear. In particular, there is a paucity of data on long-term outcomes. In this study, 395 patients enrolled in the National Heart, Lung, and Blood Institute Dynamic Registry who underwent stenting of SVG lesions with BMS (n = 192) from 1999 to 2006 or DES (n = 203) from 2004 to 2006 were analyzed. Patients were followed prospectively for the occurrence of cardiovascular events and death at 3 years. Patients treated with DES were more likely to have diabetes mellitus and other co-morbidities and previous percutaneous coronary intervention. Treated lesions in DES patients were more complex than those in BMS patients. At 3 years of follow-up, the adjusted risk for target vessel revascularization (hazard ratio 1.03, 95% confidence interval 0.65 to 1.62, p = 0.91) and death or myocardial infarction (hazard ratio 0.72, 95% confidence interval 0.49 to 1.04, p = 0.08) was similar in patients treated with DES and those treated with BMS. The combined outcome of death, myocardial infarction, or target vessel revascularization excluding periprocedural myocardial infarction was also similar (adjusted hazard ratio 0.82, 95% confidence interval 0.62 to 1.09, p = 0.16). In conclusion, this multicenter nonrandomized study of unselected patients showed no benefit of DES in SVG lesions, including no reduction in target vessel revascularization, compared with BMS at 3 years. An adequately powered randomized controlled trial is needed to determine the optimal stent type for SVG percutaneous coronary intervention.
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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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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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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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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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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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