Drug-eluting stents appear superior to bare metal stents for vein-graft PCI in vessels up to a stent diameter of 4 mm
Abstract
Overview
Background. Research trials have shown improved short-term outcome with drug-eluting stents (DES) over bare
metal stents (BMS) in saphenous vein graft (SVG) percutaneous coronary intervention (PCI), primarily by reducing
target vessel revascularization (TVR) for in-stent restenosis. We compared the outcomes in patients undergoing
SVG stent implantation treated with DES or BMS. In exploratory analyses we investigated the influence of stent
generation and diameter.
Methods. Data were obtained from a prospective database of 657 patients who underwent PCI for SVG lesions
between 2003 and 2011. A total of 344 patients had PCI with BMS and 313 with DES. Propensity scores were developed
based on 15 observed baseline covariates in a logistic regression model with stent type as the dependent
variable. The nearest-neighbour-matching algorithm with Greedy 5-1 Digit Matching was used to produce two patient
cohorts of 313 patients each. We assessed major adverse cardiac events (MACE) out to a median of 3.3 years
(interquartile range: 2.1-4.1). MACE was defined as all-cause mortality, myocardial infarction (MI), TVR and stroke.
Results. There was a significant difference in MACE between the two groups in favour of DES (17.9% DES vs.
31.2% BMS group; p = 0.0017) over the 5-year follow-up period. MACE was driven by increased TVR in the BMS
group. There was no difference in death, MI or stroke. Adjusted Cox analysis confirmed a decreased risk of MACE
for DES compared with BMS 0.75 (95% confidence interval (CI) 0.52-0.94), with no difference in the hazard of allcause
mortality (hazard ratio: 1.08; 95% CI: 0.77-1.68). However, when looking at stent diameters greater than
4 mm, no difference was seen in MACE rates between BMS and DES.
Conclusions. Overall in our cohort of patients who had PCI for SVG disease, DES use resulted in lower MACE rates
compared with BMS over a 5-year follow-up period; however, for stent diameters over 4 mm no difference in
MACE rates was seen.
Keywords
Bare metal stent, Drug-eluting stent, Percutaneous intervention, Stroke, Target vessel revascularisation, Venous graft
Article Information
Disclosure
Financial support: No grants or funding have been received for this
study.
Correspondence
Dr. Roshan Weerackody Barts Heart Centre Barts Health NHS Trust West Smithfield EC1A 7BE, London, UK Roshan.weerackody@bartshealth.nhs.uk
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