No benefit of sealing saphenous vein graft lesions with DES
medwireNews: Sealing intermediate nonobstructive saphenous vein graft (SVG) lesions with drug-eluting stents (DES) does not reduce the incidence of cardiac events in patients with a previous coronary artery bypass graft (CABG) compared with medical treatment, results of the VELETI II trial suggest.
Josep Rodés-Cabau (Quebec Heart and Lung Institute, Quebec City, Canada) and colleagues showed that after a median follow-up of 3.4 years, the incidence of major adverse cardiac events (MACE) related to the target SVG was similar in patients undergoing DES implantation versus medical treatment of SVG lesions, with corresponding rates of 15% and 20% (hazard ratio [HR]=0.65).
“Sealing [SVG] lesions with DES (mainly paclitaxel-eluting stents) was safe but failed to significantly reduce cardiac events,” write the authors in Circulation: Cardiovascular Interventions.
Furthermore, the researchers found no significant difference in the rate of MACE related to the target SVG lesion among DES- versus medically treated patients (10.0 and 16.9%, respectively).
The authors note that their trial was terminated early due to slow enrollment, and therefore the findings should “be interpreted as hypothesis generating.”
In an accompanying editorial, Julinda Mehilli (Munich University Clinic, Germany) explains that during 6 years of recruitment, only 28% of the planned 450 patients were enrolled, and as a result “the VELETI II trial is definitely underpowered.”
Rodés-Cabau and colleagues’ study included a total of 125 patients who had previously undergone CABG and had developed at least one intermediate nonobstructive SVG lesion. The mean age of participants was 70.1 years, and 87.7% were male.
The authors add an additional caveat that first-generation paclitaxel-eluting stents – used in 77.8% of patients in the VELETI II trial – are “no longer used in current clinical practice.” The remaining 22.2% of patients were given everolimus-eluting stents.
Despite the limitations of the study, Mehilli believes that: “Many important lessons can be drawn from the VELETI II trial.
“[I]t suggests that similar to native coronary arteries, there is no benefit of plaque sealing in SVGs.”
She adds that the study “highlights the fact that local mechanical solutions cannot stop the rapid atherosclerosis progression of failing SVGs,” and concludes that the results extend “available scientific evidence urging the necessity to avoid vein grafts for treatment of patients with mulitvessel disease.”
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