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

Abstract

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

Drug-Eluting Stents Appear Superior to Bare Metal Stents for Vein-Graft PCI in Vessels up to a Stent Diameter of 4 mm

“…Interestingly, no difference in mortality was reported in randomized controlled trials in the sensitivity analysis ( 20 ). A further study investigating newer generation DES reveals no significant difference as compared to early-generation stents over a follow-up period of four years ( 21 ), data consistent with our study where no difference between older and newer generation DES was seen.…”

Second-generation drug-eluting stents versus bare-metal stents in saphenous vein grafts: is the choice more complicated than before?

“…Moreover the "non-additional advantage" of the second-generation DES in SVGs PCI is supported by long-term results, albeit coming from retrospective studies. In a series of 12,339 patients with SVGs lesions newer-generation everolimus-eluting stents (EES) showed similar safety and efficacy to early-generation SES and PES during long-term follow-up to four years (22). Similar results have been provided by Pokala and colleagues in a comparison between first-generation SES and PES and second-generation EES and zotarolimus-eluting stents (ZES) at two years follow-up (23).…”

Comparison of Vascular Responses Following New‐Generation Biodegradable and Durable Polymer‐Based Drug‐Eluting Stent Implantation in an Atherosclerotic Rabbit Iliac Artery Model

“…This result suggested that long‐term biocompatibility remained uncertain, even with the safest and most effective DESs in current use. Most clinical studies revealed that patients treated with current‐generation DESs uniformly experienced late target revascularization in ≈2% of cases . It could be concluded that the existence of polymer may have been responsible for the development of neoatherosclerosis, and thus biodegradable polymer‐based DESs would be expected to reduce the incidence of neoatherosclerosis.…”