Long term follow-up of drug eluting versus bare metal stents in the treatment of saphenous vein graft lesions
Luiz F. Ybarra MD
Department of Interventional Cardiology, Heart Institute-InCor, University of São Paulo, São Paulo, Brazil
Search for more papers by this authorHenrique B. Ribeiro MD
Department of Interventional Cardiology, Heart Institute-InCor, University of São Paulo, São Paulo, Brazil
Search for more papers by this authorAntonio H. Pozetti MD
Department of Interventional Cardiology, Heart Institute-InCor, University of São Paulo, São Paulo, Brazil
Search for more papers by this authorCarlos A. Campos MD
Department of Interventional Cardiology, Heart Institute-InCor, University of São Paulo, São Paulo, Brazil
Search for more papers by this authorRodrigo B. Esper MD
Department of Interventional Cardiology, Heart Institute-InCor, University of São Paulo, São Paulo, Brazil
Search for more papers by this authorPedro A. Lemos MD
Department of Interventional Cardiology, Heart Institute-InCor, University of São Paulo, São Paulo, Brazil
Search for more papers by this authorAugusto C. Lopes MD
Department of Interventional Cardiology, Heart Institute-InCor, University of São Paulo, São Paulo, Brazil
Search for more papers by this authorRoberto Kalil-Filho MD
Department of Interventional Cardiology, Heart Institute-InCor, University of São Paulo, São Paulo, Brazil
Search for more papers by this authorStephen G. Ellis MD
Department of Cardiology, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorCorresponding Author
Expedito E. Ribeiro MD
Department of Interventional Cardiology, Heart Institute-InCor, University of São Paulo, São Paulo, Brazil
Correspondence to: Expedito E. Ribeiro, Department of Interventional Cardiology, Heart Institute of the University of São Paulo, Av Dr Eneas de Carvalho Aguiar, 44, São Paulo, Brazil. E-mail: [email protected]Search for more papers by this authorLuiz F. Ybarra MD
Department of Interventional Cardiology, Heart Institute-InCor, University of São Paulo, São Paulo, Brazil
Search for more papers by this authorHenrique B. Ribeiro MD
Department of Interventional Cardiology, Heart Institute-InCor, University of São Paulo, São Paulo, Brazil
Search for more papers by this authorAntonio H. Pozetti MD
Department of Interventional Cardiology, Heart Institute-InCor, University of São Paulo, São Paulo, Brazil
Search for more papers by this authorCarlos A. Campos MD
Department of Interventional Cardiology, Heart Institute-InCor, University of São Paulo, São Paulo, Brazil
Search for more papers by this authorRodrigo B. Esper MD
Department of Interventional Cardiology, Heart Institute-InCor, University of São Paulo, São Paulo, Brazil
Search for more papers by this authorPedro A. Lemos MD
Department of Interventional Cardiology, Heart Institute-InCor, University of São Paulo, São Paulo, Brazil
Search for more papers by this authorAugusto C. Lopes MD
Department of Interventional Cardiology, Heart Institute-InCor, University of São Paulo, São Paulo, Brazil
Search for more papers by this authorRoberto Kalil-Filho MD
Department of Interventional Cardiology, Heart Institute-InCor, University of São Paulo, São Paulo, Brazil
Search for more papers by this authorStephen G. Ellis MD
Department of Cardiology, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorCorresponding Author
Expedito E. Ribeiro MD
Department of Interventional Cardiology, Heart Institute-InCor, University of São Paulo, São Paulo, Brazil
Correspondence to: Expedito E. Ribeiro, Department of Interventional Cardiology, Heart Institute of the University of São Paulo, Av Dr Eneas de Carvalho Aguiar, 44, São Paulo, Brazil. E-mail: [email protected]Search for more papers by this authorConflict of Interest: Nothing to report.
Abstract
Introduction
The safety and effectiveness of drug-eluting stent (DES) compared with bare metal stents (BMS) for the treatment of saphenous vein graft (SVG) disease is controversial, especially because of the lack of long-term follow-up. The aim of this study was to address the late outcome of DES versus BMS for the treatment of SVG lesions.
Methods
A matched, case-control study included 82 patients in each group. Patients groups were matched by gender, age, clinical presentation, and diabetes. The primary study end point was occurrence of major adverse cardiovascular events (MACE). Secondary end points included death, cardiac death, myocardial infarction (MI), and target vessel revascularization (TVR).
Results
Clinical and angiographic characteristics were similar between the groups. At 6 months, TVR (hazard ratio [HR] 6.12, 95% confidence interval [CI] 1.39 to 26.93, P = 0.05), and MACE (HR 2.54, 95% CI 1.08 to 5.98, P = 0.04) were higher in the BMS group. At 4 years the risks of MI (P = 0.21), TVR (P = 0.99), and MACE (P = 0.21) were similar between both groups. However, the rates of death (HR 2.74, 95% CI 1.11 to 6.74, P = 0.04) and cardiac death (HR 4.26, 95% CI 1.59 to 11.35, P = 0.01) were significantly higher in the BMS group.
Conclusions
These results suggest that the use of DES compared with BMS in the treatment of SVG lesions reduces TVR and MACE at 6 months of follow-up, a benefit that was lost over the next 3–4 years. © 2012 Wiley Periodicals, Inc.
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