A comparison of first- and second-generation drug-eluting stents in saphenous vein grafts

Abstract

Purpose: To compare mid-term clinical outcomes between second-generation versus first-generation drug-eluting stents (DES) in saphenous vein grafts (SVG).Data regarding the use of second-generation DES in SVG is lacking from currently available literature. Methods: Patients treated with first-generation DES (127 patients with 143 lesions) between April 2002 and March 2006 and those treated with second-generation DES between January 2005 and April 2011 (84 patients with 100 lesions) were included in the study. Major adverse cardiac events (MACE) defined as the composite of all-cause death, myocardial infraction (MI) and target vessel revascularization (TVR), as well as TVR and target lesion revascularization (TLR) separately were evaluated at 30-day, 12-month and 18-month follow-up. Results: Baseline characteristics were similar between the two groups. Older grafts were treated with second-generation DES (11.6±5.3 years vs. 14.3±6.0 years, p=0.001). Stent length was longer in the first-generation group (34.1±25.1 mm vs. 30.5±19.4 mm, p=0.006) and maximum balloon diameter was smaller in the second-generation group (3.42±0.42 mm vs. 3.30±0.41 mm, p=0.003). Embolic protection device use was higher in the second-generation DES group (72.0% vs. 55.2%, p=0.012). At 18-month follow-up, MACE rates for the first- and second-generation groups were 24.4% vs. 20.2%, (p=0.479). TVR and TLR rates were 18.1% vs. 14.2%, (p=0.465) and 15.0% vs. 10.7%, (p= 0.373), respectively. View this table: Table 1. Clinical outcomes at 30-day, 12-month and 18-month Conclusions: Second-generation DES use in SVG appears to be associated with at least comparable clinical outcomes as compared to first-generation DES at mid-term follow-up.