Abstract 19031: Comparison of Drug-eluting Stents to Bare Metal Stents for Saphenous Vein Graft Stenosis: Longest Available Follow-up Analysis
Background: Short term outcomes studies comparing bare metal stents (BMS) and drug-eluting stents (DES) in treatment of saphenous vein graft (SVG) stenosis are conflicting and inconsistent. A recent randomized controlled trial and meta-analysis suggest that DES and BMS achieve similar outcomes on intermediate term follow-up. We thus compared long-term outcomes of DES and BMS in our SVG patients.
Methods: 247 SVG patients undergoing stenting from August 2002 – December 2008 were studied. Overall survival and event-free survival were compared by Kaplan-Meier method. Hazard ratios (HR) were calculated by Cox-proportional hazards models.
Results: We treated 133 patients with DES (median follow-up 4 years) and 114 patients with BMS (median follow-up 4 years) for SVG stenosis. Baseline characteristics were similar between the two groups. Overall survival (72.2%, vs. 66.7%, p = 0.65, Figure 1a) and major adverse cardiovascular event-free survival (53.4% vs. 51.3%, p=0.84) were not significantly different between DES and BMS groups. Although BMS was associated with increased risk of target lesion revascularization (TLR) (15.8% vs. 8.3%, HR 2.17, 95% CI 1.03–4.59, p=0.038, figure 1b), there was no significant difference in the risk of myocardial infarction (14% vs. 10.5%, p = 0.31), target vessel revascularization (23.7% vs. 19.5%, p=0.28) or device related major adverse cardiovascular events (45.1% vs. 38.3%, p = 0.29) between the two groups.
Conclusion: Although mortality is similar between DES and BMS for SVG stenosis, BMS is associated with increased risk of revascularization, thus suggesting the superiority of DES over BMS in the long term.
- © 2010 by American Heart Association, Inc.