| Autor: |
Durney, Philip, Fischman, David L, Ruggiero, Nicholas J, McCarey, Melissa, Walinsky, Paul, Gannon, Michael P, Savage, Michael P |
| Zdroj: |
Circulation (Ovid); November 2019, Vol. 140 Issue: Supplement 1 pA11921-A11921, 1p |
| Abstrakt: |
Introduction:In native coronary arteries, drug-eluting stents (DES) improve clinical outcomes compared to bare metal stents (BMS) and newer generation DES have proven superior to first generation DES. In contrast, recent meta-analyses of saphenous vein graft (SVG) intervention have not demonstrated a significant benefit of DES over BMS in SVG. It remains uncertain whether or not newer generation DES confer better outcomes than first generation DES in SVG.Objectives:The goal of this study was to compare the long term clinical outcomes of newer and first generation DES in SVG.Methods:Outcomes of 183 consecutive patients undergoing percutaneous coronary intervention (PCI) of 285 SVG lesions were evaluated. The primary outcome was the occurrence of a major adverse cardiac event (MACE) during a mean follow-up of 5.6 years. MACE was defined as any of the following: death, stroke, myocardial infarction, repeat bypass surgery, repeat target vessel revascularization, or stent thrombosis. MACE rates of patients with newer generation DES and first generation DES were compared.Results:The study population consisted of 149 men and 34 women aged 69+10 years. Acute coronary syndromes were present in 116 (63%) and diabetes in 83 (45%). Mean SVG age was 12+6 years. Clinical characteristics were similar for the first and newer generation DES groups. First generation DES were 81% sirolimus and 19% paclitaxel; newer generation DES were 92% everolimus and 8% zotarolimus. There was no difference in long term MACE-free survival between first and newer generation DES (see Figure). MACE-free survival over time for first and newer generation DES, respectively, was: 83 vs 84% at 1 year; 43 vs 38% at 5 years; and 25 vs 17% at 8 years.Conclusions:Long term outcome after PCI of SVG persists as a serious clinical challenge. The majority of patients experience a MACE within 5 years. The use of newer generation DES have not improved on these sobering results. |
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