Drug-eluting stents preferred option for saphenous vein graft lesion patients
MedWire News: Drug-eluting stents (DES) should be the treatment of choice in patients undergoing percutaneous coronary intervention (PCI) for de novo saphenous vein graft lesions, say researchers in The Lancet.
In the study conducted by Julinda Mehilli (Deutsches Herzzentum, Munich, Germany) and team, DES were associated with better clinical and angiographic outcomes up to 1 year, compared with bare-metal stents (BMS).
The trial randomly assigned 610 patients with de novo saphenous vein graft lesions in a 1:1:1:3 ratio to receive treatment with one of three DES (permanent polymer paclitaxel-eluting stents, permanent polymer sirolimus-eluting stents, biodegradable polymer sirolimus-eluting stents) or BMS.
Randomization took place immediately after crossing of the lesion with a guidewire, and was stratified for each participating center.
The primary endpoint was the combined incidence of death, myocardial infarction (MI), and target lesion revascularization at 1 year.
The results revealed that the incidence of the primary endpoint was significantly reduced by 36% in the 303 patients who received DES compared with the 307 patients who received BMS (p=0.02).
This association was largely driven by the significant reduction of target lesion revascularization by 51% with DES compared with BMS (p=0.01), report the authors.
The reduction may have been caused by the increased antirestenotic efficacy of DES in saphenous vein grafts, they speculate.
In contrast, no significant differences were seen between DES and BMS patients regarding the rates of all-cause mortality, MI, or definite or probable stent thrombosis.
"The findings of this trial support further broadening of the indication for the use of DES in patients with coronary artery disease to include patients with lesions in saphenous vein grafts," write Mehilli et al.
In a related commentary, David Taggart (University of Oxford, UK) and Adrian Banning (John Radcliffe Hospital, Oxford, UK) said: "Cardiac surgeons should look to urgently increase their use of arterial grafts, thus restricting the population likely to experience the adverse consequences of degenerative vein graft disease in the future."
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By Piriya Mahendra