Document Detail

Stent placement compared with balloon angioplasty for obstructed coronary bypass grafts. Saphenous Vein De Novo Trial Investigators.
MedLine Citation:
PMID:  9287229     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Treatment of stenosis in saphenous-vein grafts after coronary-artery bypass surgery is a difficult challenge. The purpose of this study was to compare the effects of stent placement with those of balloon angioplasty on clinical and angiographic outcomes in patients with obstructive disease of saphenous-vein grafts. METHODS: A total of 220 patients with new lesions in aortocoronary-venous bypass grafts were randomly assigned to placement of Palmaz-Schatz stents or standard balloon angioplasty. Coronary angiography was performed during the index procedure and six months later. RESULTS: As compared with the patients assigned to angioplasty, those assigned to stenting had a higher rate of procedural efficacy, defined as a reduction in stenosis to less than 50 percent of the vessel diameter without a major cardiac complication (92 percent vs. 69 percent, P<0.001), but they had more frequent hemorrhagic complications (17 percent vs. 5 percent, P<0.01). Patients in the stent group had a larger mean (+/-SD) increase in luminal diameter immediately after the procedure (1.92+/-0.30 mm, as compared with 1.21+/-0.37 mm in the angioplasty group; P<0.001) and a greater mean net gain in luminal diameter at six months (0.85+/-0.96 vs. 0.54+/-0.91 mm, P=0.002). Restenosis occurred in 37 percent of the patients in the stent group and in 46 percent of the patients in the angioplasty group (P=0.24). The outcome in terms of freedom from death, myocardial infarction, repeated bypass surgery, or revascularization of the target lesion was significantly better in the stent group (73 percent vs. 58 percent, P = 0.03). CONCLUSIONS: As compared with balloon angioplasty, stenting of selected venous bypass-graft lesions resulted in superior procedural outcomes, a larger gain in luminal diameter, and a reduction in major cardiac events. However, there was no significant benefit in the rate of angiographic restenosis, which was the primary end point of the study.
M P Savage; J S Douglas; D L Fischman; C J Pepine; S B King; J A Werner; S R Bailey; P A Overlie; S H Fenton; J A Brinker; M B Leon; S Goldberg
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The New England journal of medicine     Volume:  337     ISSN:  0028-4793     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  1997 Sep 
Date Detail:
Created Date:  1997-09-11     Completed Date:  1997-09-11     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  740-7     Citation Subset:  AIM; IM    
Jefferson Medical College, Philadelphia, PA 19107, USA.
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MeSH Terms
Angioplasty, Transluminal, Percutaneous Coronary*
Coronary Angiography
Coronary Artery Bypass
Coronary Disease / mortality,  surgery,  therapy*
Disease-Free Survival
Graft Occlusion, Vascular / therapy*
Middle Aged
Prospective Studies
Comment In:
N Engl J Med. 1998 Jan 15;338(3):198-9   [PMID:  9441229 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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