Real-world experience of drug-eluting stents in saphenous vein grafts compared to native coronary arteries: results from the prospective multicenter German DES.DE registry

Abstract

Bypass-graft intervention was associated with worse outcomes in the bare-metal stent era. Without sufficiently powered data from subgroup analyses, and in absence of randomized controlled trials targeting clinical endpoints, controversy is ongoing over safety and efficacy of drug-eluting stents (DES) in saphenous vein graft (SVG) lesions. Between October 2005 and October 2006, 5,183 patients receiving DES in SVG (n=251) or native coronary arteries (NCA) (n=4,932) were enrolled at 98 DES.DE sites. The composite of death, myocardial infarction (MI), and stroke defined as major adverse cardiac and cerebrovascular events (MACCE) and target-vessel revascularization (TVR) were defined as primary endpoints. Baseline clinical and descriptive morphology of coronary artery disease revealed more severe lesions and comorbidities in the SVG group. At 1-year follow-up, the SVG group suffered from higher rates of overall death (6.6 vs. 2.5%; p<0.0001), myocardial infarction (5.9 vs. 2.2%; p<0.0001), MACCE (13.6 vs. 5.4%; p<0.0001), TVR (17.7 vs. 10.4%; p<0.001) and overall stent thrombosis (10.0 vs. 3.7%; p<0.0001). Data collected in DES.DE revealed that first generation DES used in SVG lesions did not offset the worse clinical outcomes of bypass-graft intervention. Such sobering results in SVG may suggest to opt for native vessel PCI preferentially or occasionally for surgical reintervention as decided by the Heart Team.