Author + information
- Received June 1, 2011
- Accepted June 14, 2011
- Published online September 1, 2011.
- Dennis T. Ko, MD, MSc⁎,†,⁎ (, )
- Helen Guo, MSc†,
- Harindra C. Wijeysundera, MD⁎,
- Mohammad I. Zia, MD⁎,
- Vladimír Džavík, MD‡,
- Michael W.A. Chu, MD§,
- Stephen E. Fremes, MD⁎,
- Eric A. Cohen, MD⁎ and
- Jack V. Tu, MD, PhD⁎,†
- ↵⁎Reprint requests and correspondence
: Dr. Dennis T. Ko, Institute for Clinical Evaluative Sciences G1–06, 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5
Objectives The purpose of this study was to evaluate the long-term safety and effectiveness of drug-eluting stents (DES) for the treatment of saphenous vein graft (SVG) disease.
Background DES are frequently implanted for SVG interventions, but some studies have shown that they are not effective in reducing target vessel revascularization (TVR) over longer-term follow-up. Some studies suggest there is increased mortality with DES compared with bare-metal stents (BMS).
Methods We performed propensity score matching analysis using a population-based cohort that included 709 well-matched pairs (n = 1,418) who received DES or BMS for the treatment of SVG disease from 2003 to 2008. Outcomes of interest included repeat TVR, myocardial infarction, and death.
Results The mean age of the propensity-matched cohort was 69 years, 50% had diabetes, and the mean age of SVG was 10.6 years. At 4-year follow-up, the rate of repeat TVR was 21% in the DES group and 27.6% in the BMS group (p = 0.004). DES implantation was associated with the largest TVR reduction among patients with diabetes and patients receiving longer stents (≥30 mm) and the number of procedures needed to prevent a TVR at 4 years was 8 and 7, respectively. The composite rate of myocardial infarction or death was not significantly different between DES and BMS at 4 years (27.8% vs. 32.6%, p = 0.09).
Conclusions Implantation of DES in the treatment of SVG disease is associated with substantial reduction of repeat revascularization, without evidence of an increased risk of myocardial infarction or death at longer-term follow-up.
This analysis of the study was funded in part by an operating grant from the Canadian Institutes of Health Research (CIHR) MOP (102487). Dr. Ko is supported by a New Investigator Award from CIHR. Dr. Wijeysundera is supported by a CIHR Fellowship Award. Dr. Džavík has received research funding and speaker's honoraria from Abbott Vascular and speaker's honoraria and educational funding from Cordis, Johnson & Johnson. Dr. Chu has received speaker's honorarium from Medtronic Inc. Dr. Cohen has received speaker's honoraria, research funding, and consulting fees from Abbott Vascular, Boston Scientific, Medtronic Inc. Dr. Tu is supported by a Canada Research Chair in Health Services Research and a Career Investigator Award from the Heart and Stroke Foundation of Ontario. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 1, 2011.
- Accepted June 14, 2011.
- American College of Cardiology Foundation