CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY
Treatment of saphenous vein graft lesions with drug-eluting stents
Immediate and midterm outcome
Lei Ge, MD*, ,
Ioannis Iakovou, MD*,
Giuseppe M. Sangiorgi, MD*,
Alaide Chieffo, MD*,
Gloria Melzi, MD*,
John Cosgrave, MD*,
Matteo Montorfano, MD*,
Iassen Michev, MD*,
Flavio Airoldi, MD*,
Mauro Carlino, MD*,
Nicola Corvaja, MD* and
Antonio Colombo, MD, FACC*,*
* EMO Centro Cuore Columbus and San Raffaele Hospital, Milan, Italy
Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
Manuscript received September 14, 2004;
revised manuscript received October 29, 2004,
accepted November 2, 2004.
* Reprint requests and correspondence: Dr. Antonio Colombo, EMO Centro Cuore Columbus, 48 Via M. Buonarroti, 20145 Milan, Italy (Email: info{at}emocolumbus.it).
OBJECTIVES: The purpose of the present report was to evaluate clinical and angiographic outcomes of drug-eluting stent (DES) implantation in saphenous vein graft (SVG) lesions.
BACKGROUND: The safety and efficacy of DES implantation for the treatment SVG lesions remains uncertain.
METHODS: We evaluated in-hospital and six-month outcomes in 61 consecutive patients treated with DES in SVG lesions from March 2002 to March 2004 (DES group), as compared to 89 consecutive patients treated with bare-metal stents (BMS) in the 24 months immediately before the introduction of DES (BMS group). Major adverse cardiac events (MACE) including death, myocardial infarction, target lesion revascularization (TLR), and target vessel revascularization (TVR) were recorded in-hospital and at six-month follow-up.
RESULTS: The rate of in-hospital MACE was similar between the two groups (6.6% vs. 5.6%, p = 1.0). Cumulative MACE at six months was 11.5% in the DES group and 28.1% in the BMS group (p = 0.02). The DES group had a significantly lower incidence of in-segment restenosis (10.0% vs. 26.7%, p = 0.03), TLR (3.3% vs. 19.8%, p = 0.003), and TVR (4.9% vs. 23.1%, p = 0.003). By Cox regression analysis, diabetes (hazard ratio [HR]: 3.03; 95% confidence interval [CI]: 1.33 to 6.90; p = 0.008), usage of BMS (HR: 2.53; 95% CI: 1.07 to 5.97; p = 0.03), and age of SVG (HR: 1.10; 95% CI: 1.02 to 1.19; p = 0.02) were identified as predictors of MACE at six-month follow-up.
CONCLUSIONS: Compared to BMS implantation, DES implantation in SVG lesions appears safe with favorable and improved mid-term outcomes.
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Abbreviations and Acronyms
| | BMS = bare-metal stent | | CI = confidence interval | | DES = drug-eluting stent | | HR = hazard ratio | | MACE = major adverse cardiac events | | MI = myocardial infarction | | MLD = minimal lumen diameter | | RVD = reference vessel diameter | | SVG = saphenous vein graft | | TLR = target lesion revascularization | | TVR = target vessel revascularization |
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