Document Detail


Comparison of drug-eluting and bare metal stents for saphenous vein graft lesions (from the National Heart, Lung, and Blood Institute Dynamic Registry).
MedLine Citation:
PMID:  20854955     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The effectiveness and safety of drug-eluting stents (DES) compared with bare-metal stents (BMS) in saphenous vein graft (SVG) disease remains unclear. In particular, there is a paucity of data on long-term outcomes. In this study, 395 patients enrolled in the National Heart, Lung, and Blood Institute Dynamic Registry who underwent stenting of SVG lesions with BMS (n = 192) from 1999 to 2006 or DES (n = 203) from 2004 to 2006 were analyzed. Patients were followed prospectively for the occurrence of cardiovascular events and death at 3 years. Patients treated with DES were more likely to have diabetes mellitus and other co-morbidities and previous percutaneous coronary intervention. Treated lesions in DES patients were more complex than those in BMS patients. At 3 years of follow-up, the adjusted risk for target vessel revascularization (hazard ratio 1.03, 95% confidence interval 0.65 to 1.62, p = 0.91) and death or myocardial infarction (hazard ratio 0.72, 95% confidence interval 0.49 to 1.04, p = 0.08) was similar in patients treated with DES and those treated with BMS. The combined outcome of death, myocardial infarction, or target vessel revascularization excluding periprocedural myocardial infarction was also similar (adjusted hazard ratio 0.82, 95% confidence interval 0.62 to 1.09, p = 0.16). In conclusion, this multicenter nonrandomized study of unselected patients showed no benefit of DES in SVG lesions, including no reduction in target vessel revascularization, compared with BMS at 3 years. An adequately powered randomized controlled trial is needed to determine the optimal stent type for SVG percutaneous coronary intervention.
Authors:
Drew E Baldwin; J Dawn Abbott; Jeffrey C Trost; Helen A Vlachos; Faith Selzer; Ruchira Glaser; Robert L Wilensky; James N Slater; Serge Doucet; Srihari S Naidu; Herbert D Aronow; David O Williams
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study; Research Support, N.I.H., Extramural     Date:  2010-08-11
Journal Detail:
Title:  The American journal of cardiology     Volume:  106     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-21     Completed Date:  2010-10-26     Revised Date:  2013-05-27    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  946-51     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 Elsevier Inc. All rights reserved.
Affiliation:
Tulane Heart and Vascular Institute, Tulane University, New Orleans, Louisiana, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Coronary Artery Disease / therapy*
Drug-Eluting Stents*
Female
Humans
Male
Saphenous Vein
Treatment Outcome
Grant Support
ID/Acronym/Agency:
HL033292/HL/NHLBI NIH HHS; U01 HL033292-15/HL/NHLBI NIH HHS; U01 HL033292-16/HL/NHLBI NIH HHS; U01 HL033292-17/HL/NHLBI NIH HHS; U01 HL033292-18/HL/NHLBI NIH HHS; U01 HL033292-19/HL/NHLBI NIH HHS; U01 HL033292-20/HL/NHLBI NIH HHS; U01 HL033292-21/HL/NHLBI NIH HHS; U01 HL033292-22/HL/NHLBI NIH HHS; U01 HL033292-23/HL/NHLBI NIH HHS; U01 HL033292-24/HL/NHLBI NIH HHS; U01 HL033292-25/HL/NHLBI NIH HHS
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