Abstract
Introduction: Drug-eluting stents (DES) have been shown to have superior short term outcomes in the treatment of saphenous vein graft (SVG) disease compared to bare metal stents. Hypothesis: The goal of this study was to assess the long term clinical outcome of all patients with SVG disease treated with DES. Methods: 183 consecutive patients undergoing SVG intervention with DES were evaluated. Post-procedure, antiplatelet therapy included aspirin indefinitely and dual antiplatelet therapy for a minimum of 1 year. Major adverse cardiac events (MACE) were assessed at a mean follow-up of 5 years. MACE was defined as any of the following: death, stroke, myocardial infarction, repeat bypass surgery, repeat target vessel revascularization, or stent thrombosis. Results: The study population consisted of 149 men and 34 women with a mean age of 69 ± 10 years. Diabetes was present in 83 (45%) and acute coronary syndromes were present in 116 (63%). Mean SVG age was 12 ± 6 years. Diffuse disease (≥ 30 mm of treated disease and/or 3 or more lesions in a single vessel) was present in 37%. A total of 243 lesions were treated with 395 DES. Procedural techniques during DES deployment included direct stenting in 50%, pretreatment with intracoronary nicardipine in 49%, and use of a distal protection device in 38%. Kaplan Meier analysis of long-term MACE free survival is shown in the Figure. Although only 18% of patients had a MACE at one year, continued events were common after the first year. At 49 months, 50% of the patients had one or more MACE. Event free survival which was 82% at 1 year was only 41% at 5 years. MACE free survival after first and second generation DES were similar. Conclusions: The long-term outcome after percutaneous intervention of aortocoronary bypass vein grafts continues to present a clinical challenge. Within 5 years after DES placement for SVG disease, fewer than half of the patients remain event free.
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