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Guttmann OP, Jones DA, Safwan KA, et al. Drug-eluting stents appear superior to bare metal stents for vein-graft PCI in vessels up to a stent diameter of 4 mm. Heart Int. 2016;11(1):e17-e24doi: 10.5301/heartint.5000228.
Guttmann, O. P., Jones, D. A., Safwan, K. A., Gallagher, S., Rathod, K. S., Hamshere, S., Smith, E. J., Jain, A. K., Mathur, A., Wragg, A., Knight, C. J., & Weerackody, R. (2016). Drug-eluting stents appear superior to bare metal stents for vein-graft PCI in vessels up to a stent diameter of 4 mm. Heart international, 11(1), e17-e24. https://doi.org/10.5301/heartint.5000228
Guttmann, Oliver P, et al. "Drug-eluting stents appear superior to bare metal stents for vein-graft PCI in vessels up to a stent diameter of 4 mm." Heart international vol. 11,1 (2016): e17-e24. doi: https://doi.org/10.5301/heartint.5000228
Guttmann OP, Jones DA, Safwan KA, Gallagher S, Rathod KS, Hamshere S, Smith EJ, Jain AK, Mathur A, Wragg A, Knight CJ, Weerackody R. Drug-eluting stents appear superior to bare metal stents for vein-graft PCI in vessels up to a stent diameter of 4 mm. Heart Int. 2016 May 12;11(1):e17-e24. doi: 10.5301/heartint.5000228. eCollection 2016. PMID: 27924213; PMCID: PMC5072290.
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Heart Int. 2016 May 12;11(1):e17-e24. doi: 10.5301/heartint.5000228. eCollection 2016.

Drug-eluting stents appear superior to bare metal stents for vein-graft PCI in vessels up to a stent diameter of 4 mm.

Heart international

Oliver P Guttmann, Daniel A Jones, Kassem A Safwan, Sean Gallagher, Krishnaraj S Rathod, Steve Hamshere, Elliot J Smith, Ajay K Jain, Anthony Mathur, Andrew Wragg, Charles J Knight, Roshan Weerackody

Affiliations

  1. Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London - UK.
  2. Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London - UK; Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London - UK; NIHR Cardiovascular Biomedical Research Unit, Barts Heart Centre, Barts Health NHS Trust, London - UK.
  3. Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London - UK; NIHR Cardiovascular Biomedical Research Unit, Barts Heart Centre, Barts Health NHS Trust, London - UK.

PMID: 27924213 PMCID: PMC5072290 DOI: 10.5301/heartint.5000228

Abstract

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 all-cause 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

Conflict of interest statement

None.

References

  1. Prog Cardiovasc Dis. 1991 Jul-Aug;34(1):45-68 - PubMed
  2. N Engl J Med. 2007 Mar 8;356(10):1030-9 - PubMed
  3. Lancet. 2011 Sep 17;378(9796):1071-8 - PubMed
  4. Circulation. 2001 Apr 17;103(15):1967-71 - PubMed
  5. Am J Cardiol. 2010 Nov 15;106(10):1376-81 - PubMed
  6. JACC Cardiovasc Interv. 2009 Nov;2(11):1105-12 - PubMed
  7. Am J Cardiol. 2005 Nov 1;96(9):1254-9 - PubMed
  8. EuroIntervention. 2014;9(12):1432-40 - PubMed
  9. JACC Cardiovasc Interv. 2010 Oct;3(10):1068-73 - PubMed
  10. J Am Coll Cardiol. 2005 Mar 15;45(6):947-53 - PubMed
  11. J Am Coll Cardiol. 2009 Mar 17;53(11):929-30 - PubMed
  12. Circ Cardiovasc Interv. 2010 Dec;3(6):565-76 - PubMed
  13. J Am Coll Cardiol. 2005 Apr 19;45(8):1186-92 - PubMed
  14. N Engl J Med. 2007 Mar 8;356(10):1020-9 - PubMed
  15. Clin Sci (Lond). 2008 Feb;114(3):211-20 - PubMed
  16. Catheter Cardiovasc Interv. 2008 Jul 1;72(1):7-12 - PubMed
  17. Am J Clin Pathol. 1998 Sep;110(3):378-84 - PubMed
  18. Circulation. 1998 Mar 10;97(9):916-31 - PubMed
  19. N Engl J Med. 2003 Oct 2;349(14):1315-23 - PubMed
  20. EuroIntervention. 2010 May;6(1):149-60 - PubMed
  21. J Am Coll Cardiol. 1996 Nov 1;28(5):1134-9 - PubMed
  22. Circulation. 2006 Mar 21;113(11):1434-41 - PubMed
  23. Ann Thorac Surg. 2009 Jan;87(1):331-8 - PubMed
  24. JACC Cardiovasc Interv. 2011 Sep;4(9):965-73 - PubMed
  25. J Am Coll Cardiol. 2009 Apr 28;53(17):1488-97 - PubMed

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