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Outcomes With Drug-Eluting Versus Bare-Metal Stents in Saphenous Vein Graft Intervention

Results From the STENT (Strategic Transcatheter Evaluation of New Therapies) Group

Bruce R. Brodie, MD^_*,_*, Hadley Wilson, MD, Thomas Stuckey, MD^_*, Marcy Nussbaum, Sherry Laurent, Barbara Bradshaw, RN^_*, Angela Humphrey, Chris Metzger, MD, James Hermiller, MD^||, Fred Krainin, MD^¶, Stanley Juk, MD^#, Barry Cheek, MD^_**, Peter Duffy, MD, Charles A. Simonton, MD for the STENT Group

^_* The LeBauer Cardiovascular Research Foundation, Greensboro, North Carolina
Carolinas Medical Center, Charlotte, North Carolina
R. Stuart Dickson Institute for Health Studies, Charlotte, North Carolina
Holston Valley Medical Center, Kingsport, Tennessee
^|| Indiana Heart Institute, Indianapolis, Indiana
^¶ McLeod Regional Medical Center, Florence, South Carolina
^# Sisters of Charity Providence Hospitals, Columbia, South Carolina
^_** High Point Regional Health System, High Point, North Carolina
Moore Regional Medical Center, Pinehurst, North Carolina

^_* Reprint requests and correspondence: Dr. Bruce R. Brodie, Lebauer Cardiovascular Research Foundation, Moses Cone Health System, 313 Meadowbrook Terrace, Greensboro, North Carolina 27408 (Email: bbrodie{at}triad.rr.com).

Objectives: This study compares outcomes of drug-eluting stents (DES) versus bare-metal stents (BMS) in patients undergoing saphenous vein graft (SVG) intervention.

Background: The safety and efficacy of DES in patients undergoing SVG intervention is controversial.

Methods: The STENT (Strategic Transcatheter Evaluation of New Therapies) registry is a multicenter U.S. registry evaluating outcomes with DES. Our study population includes patients undergoing PCI of SVG lesions with DES (n = 785) or BMS (n = 343) who completed 9-month or 2-year follow-up. Outcomes were adjusted with propensity analyses.

Results: The DES patients had fewer emergent procedures but had smaller vessels and longer lesions. The DES patients had less death or myocardial infarction at 9 months (hazard ratio [HR]: 0.52, 95% confidence interval [CI]: 0.33 to 0.83, p = 0.006) and less death at 2 years (HR: 0.60, 95% CI: 0.36 to 0.98, p = 0.041). Target vessel revascularization (TVR) was less with DES at 9 months (7.2% vs. 10.0%, HR: 0.36, 95% CI: 0.22 to 0.61, p < 0.001) but was no different by 2 years (18.3% vs. 16.9%, p = 0.86), although adjusted TVR rates were lower (HR: 0.60, 95% CI: 0.40 to 0.90, p = 0.014). The DES reduced TVR at 9 months in SVG lesions with diameter <3.5 mm (8.0% vs. 17.2%, p = 0.013) but not 3.5 mm (6.0% vs. 6.6%, p = 0.74).

Conclusions: Treatment of SVG lesions with DES vs. BMS is effective in reducing TVR at 9 months, although most of this advantage is lost at 2 years. The DES seem safe with less death or myocardial infarction, although selection bias might have affected these results. Our data suggest that DES might have short-term advantages over BMS in SVG lesions with diameter <3.5 mm.

Key Words: drug-eluting stents • saphenous vein grafts

Abbreviations and Acronyms   BMS = bare-metal stent(s)   DES = drug-eluting stent(s)   PCI = percutaneous coronary intervention   SVG = saphenous vein graft   TIMI = Thrombolysis In Myocardial Infarction   TLR = target lesion revascularization   TVR = target vessel revascularization

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