Long-Term Outcomes with First vs. Second-Generation Drug-Eluting Stents in Saphenous Vein Graft Lesions. Nagendra R. Pokala. Catheterization and cardiovascular Intervention 2016;87:34-40
Courtesy of del Dr. Carlos Fava.
Second generation DES have been proved superior to first generation DES in native arteries, but there is limited information on DES in saphenous vein grafts (SVG), from a few small studies.
This study included 81 patients receiving first generation DES and 166 receiving second generation DES.
There were no differences in both populations, with the exception of more frequent unstable angina in the first generation group.
In the first generation cohort, stenting was more frequent on SVG, and in the second generation cohort, on the anastomosis. Distal protection was more frequent in the second generation cohort.
The procedure had similar success in both groups, with a very low complications rate.
Over 41 months follow up, there were no differences in the combined primary end point of death, MI or revascularization (43.5% vs. 40.87%; p= 0.707).
Looking at each of the factors separately, researchers observed a similar events rate in both groups (death 20.91% vs. 20.27%; p=0.916, target lesion revascularization 16.39% vs. 20.00%; p= 0.572, vessel revascularization 20.97% vs. 23.16%; p= 0.747 and AMI 26.15% vs. 23.00% respectively; p= 0.644). Neither were there significant differences in stent thrombosis rates.
Conclusion
First and second generation DES outcomes in saphenous vein grafts are similar. New designs are needed to improve the evolution of this challenging group of patients.
Editorial Comment
DES have been designed for native arteries with arteriosclerosis. Saphenous vein grafts have a rather different structure and disease, with a higher risk of embolism.
It is necessary to develop stents especially designed for SVG to be able to reduce MACE to comparable levels of native vessel stenting.
Courtesy of del Dr. Carlos Fava.
Interventional Cardiologist
Favaloro Foundation – Argentina