Increased Late Mortality After Sirolimus-Eluting Stents Versus Bare-Metal Stents in Diseased Saphenous Vein Grafts

Vermeersch, Paul; Agostoni, Pierfrancesco; Verheye, Stefan; Heuvel, Paul Van den; Convens, Carl; Branden, F. Van Den; Langenhove, Glenn Van; Rrisc, Delayed

doi:10.1016/j.jacc.2007.05.010

Cited by 254 publications

(108 citation statements)

References 28 publications

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“…Our study results conflict with those from the DELAYED RRISC trial, which concluded that there was a significant mortality increase in those patients receiving DES compared to BMS [26]. The DELAYED RRISC analysis was a secondary post hoc analysis, and the study size was inadequately powered to detect mortality differences.…”

Section: Discussioncontrasting

confidence: 91%

“…The efficacy of DES in SVG remains uncertain due to contradictory data that supports lower rates of revascularization with DES [11][12][13][14][15][16][17][18][19]; clinical equivalence to BMS [20][21][22][23][24]; or even an excess of clinical events associated with the use of DES in SVG disease [25][26][27]. Indeed, the DELAYED RRISC trial showed increased mortality in patients treated with DES.…”

Section: Introductionmentioning

confidence: 99%

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Long‐term outcomes of drug‐eluting stents versus bare‐metal stents in saphenous vein graft disease: Results from the Prairie “Real World” Stent Registry

Goswami

Gaffigan

Berrio

et al. 2009

Cathet Cardio Intervent

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Objectives: This study was designed to compare long-term clinical outcomes of drugeluting stents (DES) versus bare metal stents (BMS) in patients with saphenous vein graft (SVG) disease in the ''real world.'' Background: The safety and efficacy of DES versus BMS in SVG remains uncertain due to contradictory reports of either lower revascularization rates with DES; or clinical equivalence to BMS; or even an excess of clinical events associated with DES use. Methods: We identified consecutive patients who underwent stent placement within a de novo SVG lesion between May 1, 2003 and July 31, 2007. Follow-up was obtained at regular intervals. The Kaplan-Meier method was used to produce actuarial survival estimates. Cox regression analysis was used to predict the risk associated with stent type, and propensity scores were generated to risk-adjust the results. Results: The study group included 379 stent recipients (284 DES; 95 BMS) with 410 stented lesions. BMS were placed more frequently in current smokers, acute myocardial infarctions, larger vessels, and longer lesions. In-hospital mortality was higher in BMS recipients than in their DES counterparts (3.2% vs. 0, respectively; P 5 0.015). At 3 years, there was no significant difference in clinical adverse event rates between DES and BMS recipients, even after risk adjustment. Conclusions: Three-year adverse event rates are similar among patients treated with DES or BMS in SVG lesions. Therefore, while DES are safe, they do not appear to offer an advantage in terms of long-term graft patency. V C 2009 Wiley-Liss, Inc.

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Section: Discussioncontrasting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Long‐term outcomes of drug‐eluting stents versus bare‐metal stents in saphenous vein graft disease: Results from the Prairie “Real World” Stent Registry

Goswami

Gaffigan

Berrio

et al. 2009

Cathet Cardio Intervent

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“…Specifically, rates of MACE at four years in the present study (46%) were similar to those reported among PES-treated patients in the randomised Stenting of Saphenous Vein Grafts (SOS) trial at 35 months of follow-up (54%) 14 . Similarly, in the Extended Duration of the Reduction of Restenosis In Saphenous vein grafts with Cypher stent (DELAYED RRISC) study 15 , rates of MACE amounted to 58% among SES-treated patients at a median follow-up of 32 months. These figures contrast with rates of MACE in the range of 20% among unselected patients enrolled in all-comers studies with the predominant treatment of native coronary artery lesions [16][17][18] .…”

Section: Discussionmentioning

confidence: 97%

Long-term comparison of everolimus-eluting stents with sirolimus- and paclitaxel-eluting stents for percutaneous coronary intervention of saphenous vein grafts

Taniwaki

Räber²,

Magro³

et al. 2014

EuroIntervention

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Aims: Newer-generation everolimus-eluting stents (EES) have been shown to improve clinical outcomes compared with early-generation sirolimus-eluting (SES) and paclitaxel-eluting stents (PES) in patients undergoing percutaneous coronary intervention (PCI). Whether this benefit is maintained among patients with saphenous vein graft (SVG) disease remains controversial. Methods and results:We assessed cumulative incidence rates (CIR) per 100 patient years after inverse probability of treatment weighting to compare clinical outcomes. The pre-specified primary endpoint was the composite of cardiac death, myocardial infarction (MI), and target vessel revascularisation (TVR). Out of 12,339 consecutively treated patients, 288 patients (5.7%) underwent PCI of at least one SVG lesion with EES (n=127), SES (n=103) or PES (n=58). Up to four years, CIR of the primary endpoint were 58.7 for EES, 45.2 for SES and 45.6 for PES with similar adjusted risks between groups (EES vs. SES; HR 0.94, 95% CI: 0.55-1.60, EES vs. PES; HR 1.07, 95% CI: 0.60-1.91). Adjusted risks showed no significant differences between stent types for cardiac death, MI and TVR.Conclusions: Among patients undergoing PCI for SVG lesions, newer-generation EES have similar safety and efficacy to early-generation SES and PES during long-term follow-up to four years. KEYWORDS

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“…This study mandated follow-up angiography and the repeat revascularization rate is well recognized to be higher in studies with required angiography rather than ischemia driven procedures. Recently the same investigators [21] reported on the extended follow-up (greater than 2 years) of their 75 randomized patients. Thirty percent (11 patients) of their sirolimus in SVG implanted patients (38 patients) died of cardiac causes as opposed to none of their BMS (37 patients) cohort.…”

Section: Discussionmentioning

confidence: 99%

“…A recent small prospective randomized trial between the Sirolimus-eluting (SES) stent and BMS [15] reported a significant reduction of late lumen loss, restenosis and repeat target lesion and vessel revascularization at 6 months with SES. Current available registries of DES in SVG [16][17][18][19][20][21] report inconsistent results and they are limited by small enrollments and short-term follow-up. Thus, the aim of our study was to assess whether the benefits of DES as opposed to BMS in SVG are maintained long term in a large cohort of patients.…”

Section: Introductionmentioning

confidence: 99%

Lack of clinical long‐term benefit with the use of a drug eluting stent compared to use of a bare metal stent in saphenous vein grafts

Gioia

Benassi

Mohendra

et al. 2008

Cathet Cardio Intervent

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Background: Small randomized trials have shown short-term improved outcome with drug-eluting stents (DES) over bare metal stent (BMS) in saphenous vein graft (SVG) interventions by reducing in-stent restenosis and target vessel revascularization (TVR). It is not clear, however, if these benefits are maintained long term. The aim of this study is to compare the outcome in a larger cohort of patients undergoing SVG stent implantation with DES or BMS, at 2 years. Methods: From among 250 patients who underwent SVG stenting, 225 patients with available follow-up were selected from data bases at the three participating institutions. One-hundred-six patients had DES (sirolimus, paclitaxel or tacrolimus eluting stent) and 119 patients had any available BMS from April 2002 to December 2006. The primary endpoint was MACE rate, a combination of cardiac death, S-T elevation myocardial infarction (STEMI) and target lesion revascularization. Secondary end points were the individual components of the primary endpoint. Follow-up was obtained by mailed interviews or telephone calls and review of the hospital chart. Results: The DES and BMS groups had similar age (71 6 8 years vs. 70 6 7 years, P 5 1.0), diabetes (45% vs. 36%, P 5 0.3), history of MI (58% vs. 51%, P 5 0.6), EF (44% vs. 47%, P 5 0.2) and previous PCI (40% vs. 35%, P 5 0.4). Reference vessel diameter (3.15 6 0.5 mm vs. 3.5 6 0.5 mm. P 5 0.001) and stent size (3.3 6 0.4 mm vs. 3.9 6 0.5 mm, P 5 0.001) were smaller in the DES group; however, the BMS were longer (24 6 10 mm vs. 21 6 6 mm, P 5 0.05). At one year there was a trend (P 5 0.1) for lower MACE rate in the DES group, but at two years there was no difference in MACE free survival between the DES and BMS groups (81 % vs. 82%, P 5 0.9). The death rate was similar (6% each) with three patients having STEMI (two in the DES and one in the BMS). TVR was also similar (14% in each group). Conclusion: In patients undergoing treatment of SVG disease with a stent, the marginal benefit of DES seen at 1 year was lost at 2-year follow-up. '

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Increased Late Mortality After Sirolimus-Eluting Stents Versus Bare-Metal Stents in Diseased Saphenous Vein Grafts

Cited by 254 publications

References 28 publications

Long‐term outcomes of drug‐eluting stents versus bare‐metal stents in saphenous vein graft disease: Results from the Prairie “Real World” Stent Registry

Long‐term outcomes of drug‐eluting stents versus bare‐metal stents in saphenous vein graft disease: Results from the Prairie “Real World” Stent Registry

Long-term comparison of everolimus-eluting stents with sirolimus- and paclitaxel-eluting stents for percutaneous coronary intervention of saphenous vein grafts

Lack of clinical long‐term benefit with the use of a drug eluting stent compared to use of a bare metal stent in saphenous vein grafts

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