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Choice of Stent for Percutaneous Coronary Intervention of Saphenous Vein Grafts

Lookup NU author(s): Dr Mark De Belder, Professor Azfar ZamanORCiD

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This is the authors' accepted manuscript of an article that has been published in its final definitive form by Lippincott Williams and Wilkins, 2017.

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Abstract

© 2017 American Heart Association, Inc. Background - There are limited data on comparison of contemporary drug-eluting stent (DES) platforms, previous generation DES, and bare-metal stents (BMS) for percutaneous coronary intervention in saphenous vein grafts (SVG). We aimed to assess clinical outcomes following percutaneous coronary intervention to SVG in patients receiving bare-metal stents (BMS), first-generation DES, and newer generation DES in a large unselected national data set from the BCIS (British Cardiovascular Intervention Society). Methods and Results - Patients undergoing percutaneous coronary intervention to SVG in the United Kingdom from January 2006 to December 2013 were divided into 3 groups according to stent use: BMS, first-generation DES, and newer generation DES group. Study outcomes included in-hospital major adverse cardiovascular events, 30-day mortality, and 1-year mortality. Patients (n=15 003) underwent percutaneous coronary intervention to SVG in England and Wales during the study period. Of these, 38% received BMS, 15% received first-generation DES, and 47% received second-generation DES. The rates of in-hospital major adverse cardiovascular events were significantly lower in patients treated with second-generation DES (odds ratio, 0.51; 95% confidence interval, 0.38-0.68; P<0.001), but not with first-generation DES, compared with BMS-treated patients. Similarly, 30-day mortality (odds ratio, 0.43; 95% confidence interval, 0.32-0.59; P<0.001) and 1-year mortality (odds ratio, 0.60; 95% confidence interval, 0.51-0.71; P<0.001) were lower in patients treated with second-generation DES, but not with first-generation DES, compared with the patients treated with BMS. Conclusions - Patients receiving second-generation DES for the treatment SVG disease have lower rates of in-hospital major adverse cardiovascular events, 30-day mortality, and 1-year mortality, compared with those receiving BMS.

Publication metadata

Author(s): Iqbal J, Kwok CS, Kontopantelis E, De Belder MA, Ludman PF, Large A, Butler R, Gamal A, Kinnaird T, Zaman A, Mamas MA

Publication type: Article

Publication status: Published

Journal: Circulation: Cardiovascular Interventions

Year: 2017

Volume: 10

Issue: 4

Online publication date: 12/04/2017

Acceptance date: 03/03/2017

Date deposited: 14/07/2017

ISSN (print): 1941-7640

ISSN (electronic): 1941-7632

Publisher: Lippincott Williams and Wilkins

URL: https://doi.org/10.1161/CIRCINTERVENTIONS.116.004457

DOI: 10.1161/CIRCINTERVENTIONS.116.004457

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