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, Nilesh; Gaffigan, Matthew; Berrio, Gadiel; Plessa, Anna L.; Pfeiffer, A; Markwell, Stephen; Mishkel, Gregory

doi:10.1002/ccd.22194

Cited by 31 publications

(14 citation statements)

References 31 publications

(36 reference statements)

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“…Periprocedural treatment with clopidogrel was more disparate among eligible studies. In most trials, clopidogrel was prescribed for at least 1 month after BMS placement 13,[17][18][19][21][22][23]25,[27][28][29]36 and for at least 3 18 -20,22,25,28 or 6 months 13,14,17,19,21,23,25,27,28,32,33,36,37 after DES implantation. In the DELAYED RISCC study, 12 clopidogrel was administered for at least 2 months in all patients.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

“…Stent thrombosis rates were available in only 15 studies. [12][13][14][15][17][18][19]21,22,24,25,27,30,33,36 Although the OR point estimate (OR, 0.54) suggests reduced risk for stent thrombosis with DES, the wide 95% CrI (0.13 to 1.39) precludes definitive conclusions regarding any benefit of DES over BMS (Figure 7) with regard to this specific end point.…”

Section: Meta-analysis Of Studied Outcomes Measuresmentioning

confidence: 99%

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Drug-Eluting or Bare Metal Stents for the Treatment of Saphenous Vein Graft Disease

Paradis

Bélisle²,

Joseph³

et al. 2010

Circ: Cardiovascular Interventions

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Background-Observational studies and randomized, controlled trials have yielded uncertain results regarding the benefits of drug-eluting stents (DES) for the treatment of saphenous vein graft (SVG) disease. The objective of this meta-analysis was to assess the cumulative evidence regarding the efficacy and effectiveness of DES to treat SVG compared with bare metal stent (BMS When combining these outcomes, the OR for major adverse cardiac events was reduced in patients treated with DES (OR, 0.62; 95% CrI, 0.46 to 0.81). Finally, the relative risk of stent thrombosis appeared lower with DES, although again the CrIs were very wide (OR, 0.54; 95% CrI, 0.13 to 1.39). Conclusions-In this study-level meta-analysis, the largest ever reported and the first using bayesian methods, the use of DES for the treatment of SVG disease reduces target vessel revascularization and target lesion revascularization procedures compared with BMS. Although there is no evidence to date to suggest increased rates of mortality, myocardial infarction, or stent thrombosis, further data are needed to address this safety issue. (Circ Cardiovasc Interv. 2010;3:565-576.)

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Section: Study Selection and Characteristicsmentioning

confidence: 99%

Section: Meta-analysis Of Studied Outcomes Measuresmentioning

confidence: 99%

Drug-Eluting or Bare Metal Stents for the Treatment of Saphenous Vein Graft Disease

Paradis

Bélisle²,

Joseph³

et al. 2010

Circ: Cardiovascular Interventions

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“…7 Depois desses estudos randomizados iniciais realizados em pequenos grupos, foram apresentadas muitas séries de populações do mundo real com lesões em EVS. [11][12][13][14][15][16][17][18][19][20] Recentemente foram publicadas duas metaanálises de ensaios randomizados e estudos observacionais, abrangendo mais de 5 mil pacientes. Meir et al 21 relataram taxas semelhantes de morte, IM e RLA em pacientes tratados com stents farmacológicos e stents não-farmacológicos em ensaios randomizados.…”

Section: Discussionunclassified

Stents farmacológicos vs. stents não-farmacológicos no tratamento de enxertos de veia safena

Collet¹,

Costa²,

Sousa³

et al. 2011

Rev. Bras. Cardiol. Invasiva

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RESUMOIntrodução: Embora os stents farmacológicos tenham reduzido acentuadamente a reestenose e a necessidade de novas revascularizações na maioria dos cenários clínicos e angiográficos, o benefício desses dispositivos no tratamento de lesões em enxertos de veia safena (EVS) ainda precisa ser definido. O objetivo deste estudo foi comparar a incidência de eventos cardíacos adversos maiores (ECAM) entre stents farmacológicos e stents não-farmacológicos em lesões em EVS em pacientes não-selecionados. Métodos: Foram incluídos pacientes tratados em dois hospitais terciários entre maio de 2006 e janeiro de 2009. O objetivo primá-rio foi comparar a incidência de ECAM entre stents farmacológicos e stents não-farmacológicos durante a hospitalização e no seguimento a longo prazo. Resultados: No total, foram incluídos, consecutivamente, 308 pacientes, divididos de acordo com o tipo de stent implantado (209 com stents farmacológicos e 99 com stents não-farmacológicos). A média de idade do grupo foi de 68 anos e a dos EVS, de 10,9 anos. Na fase intra-hospitalar, houve tendência para maior incidência de ECAM no grupo que recebeu stents farmacológicos (12% vs. 5,1%; P = 0,06). Até 24 meses, a incidência de ECAM foi equivalente nos dois grupos (17,2% no grupo stents farmacológicos vs. 18,2% no grupo stents não-farmacológicos; P = 0,87). Trombose do stent definitiva/provável foi semelhante em ambos os grupos (2,3% no grupo stents farmacológicos vs. 2% no grupo stents não-farmacológicos; P = 0,94). Conclusões: Nesta série de pacientes complexos do mundo real, não houve preocupação com a segurança a longo prazo relacionada ao uso de stents farmacológicos no tratamento de lesões em EVS, com incidências similares de morte cardíaca/infarto do miocárdio/trombose do stent em ambos os grupos. DESCRITORES:Stents. Stents farmacológicos. Veia safena. ABSTRACT Drug-Eluting Stents vs. Bare-Metal Stents in Saphenous Vein Graft LesionsBackground: Although drug-eluting stents have markedly reduced restenosis and the need for repeat lesion revascularization in the vast majority of clinical and angiographic scenarios, the benefit of these devices for the treatment of saphenous-vein graft (SVG) lesions is yet to be defined. The aim of our study was to compare the rate of major adverse clinical events (MACE) between drug-eluting stents and bare-metal stents in SVG lesions in non-selected patients. Methods: Patients treated in two tertiary hospitals betweenMay 2006 and January 2009 were included. The primary objective was to compare the incidence of MACE between drug-eluting stents and bare-metal stents during hospitalization and in the long-term follow-up. Results: Overall, 308 patients were consecutively enrolled and divided according to the type of stent deployed (209 with drug-eluting stents and 99 with bare-metal stents). Mean age was 68 years and SVG mean age was 10.9 years. In the in-hospital phase there was a trend towards higher MACE in the drug-eluting stents group (12% vs. 5.1%; P = 0.06). The incidence of MACE in up to 24 months was equi...

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“…In their meta-analysis, DESs were found to be superior to BMSs with regard to the incidence rates of MACEs (19 vs. 28%, P<0.00001), mortality (31). By contrast, other studies did not find DESs to be superior to BMSs in the long-term follow-up subsequent to SVG-PCI (17,32,33). The SOS study (17) found that the overall mortality rate did not differ significantly between the DES and BMS groups at the end of 1.5 years of follow-up (5 vs. 12%; HR, 1.56; 95% CI, 0.72-4.11; P=0.27).…”

Section: A B C Dmentioning

confidence: 95%

“…In a study of 284 patients with DESs and 95 patients with BMSs, the incidence of MACEs at 3 years did not differ significantly between the groups, despite a significantly higher inpatient mortality rate in the BMS group. This suggested a good safety profile (but non-superiority) of DESs in long-term implantation (33).…”

Section: A B C Dmentioning

confidence: 98%

Percutaneous coronary intervention strategies and prognosis for graft lesions following coronary artery bypass grafting

Liu

Zhou

Jiang

et al. 2015

Experimental and Therapeutic Medicine

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Abstract. The purpose of this study was to compare the prognosis of graft-percutaneous coronary intervention (PCI) and native vessel (NV)-PCI, drug-eluting stents (DESs) and bare-metal stents (BMSs) for the treatment of graft lesions following coronary artery bypass grafting (CABG), and to determine the risk factors for major adverse cardiac events (MACEs). A total of 289 patients who underwent PCI following CABG between August 2005 and March 2010 were retrospectively analyzed. The effects on survival were compared among patients who underwent NV-and graft-PCI, and DES and BMS implantation. Additionally, the risk factors for MACEs following PCI for graft lesions were analyzed. The findings showed that MACE-free and revascularization-free survival rates were significantly higher in the NV-PCI group compared with those in the graft-PCI group. There were 63 cases (29.0%) of MACEs in the DES group and 25 cases (52.1%) in the BMS group. In patients undergoing NV-PCI, the DES group had significantly fewer MACEs and less target vessel revascularization (TVR) than the BMS group. In patients undergoing graft-PCI, the DES group showed a tendency for fewer MACEs and a lower incidence of cardiac mortality, myocardial infarction and TVR compared with the BMS group. Diabetes, an age of >70 years and graft-PCI were independent risk factors for MACEs in patients post-PCI. It is concluded that NV-PCI has superior long-term outcomes compared with graft-PCI, and should therefore be considered as the first-line treatment for graft disease following CABG. Despite this, graft-PCI remains a viable option. DESs are the first choice for graft-PCI due to their safety and efficacy and their association with reduced mortality and MACE rate. Diabetes, older age and graft-PCI are independent risk factors for MACEs in patients post-CABG who are undergoing revascularization. IntroductionThe annual percentage of recurrences following coronary artery bypass graft (CABG) surgery that require further revascularization therapy, is ~8.6-10.4% (1). Patients with CABG have a tendency to survive longer, leading to the issue of decreased long term patency rates. The native coronary artery may also develop de novo atherosclerosis, resulting in myocardial ischemia and angina. The 10-year patency rate of the internal mammary artery graft is 85-95%, whereas the 10-year patency rate of saphenous vein grafts (SVG) is only ~40% (2-5). Furthermore, 40% of patients with not yet occluded SVG experience various extents of stenosis, the treatment of which has become a common clinical problem (6-8). Graft stenosis can be treated with secondary CABG or percutaneous coronary intervention (PCI) in either the native vessel (NV) or the graft. With significantly increased mortality, incidence of myocardial infarction, and perioperative complications, the benefit of secondary CABG is much lower, as compared with first-time CABG. Therefore, PCI has become the preferential option for revascularization following CABG treatment (9-10). The optimal percutaneous revascularizatio...

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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

Cited by 31 publications

References 31 publications

Drug-Eluting or Bare Metal Stents for the Treatment of Saphenous Vein Graft Disease

Drug-Eluting or Bare Metal Stents for the Treatment of Saphenous Vein Graft Disease

Stents farmacológicos vs. stents não-farmacológicos no tratamento de enxertos de veia safena

Percutaneous coronary intervention strategies and prognosis for graft lesions following coronary artery bypass grafting

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