Long-Term Safety and Effectiveness of Drug-Eluting Stents for the Treatment of Saphenous Vein Grafts Disease

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. (J Am Coll Cardiol Intv 2011;4:965-73) (C) 2011 by the American College of Cardiology Foundation