Long-term comparison of everolimus-eluting stents with sirolimus- and paclitaxel-eluting stents for percutaneous coronary intervention of saphenous vein grafts.

Abstract

AIMS:

Newer-generation everolimus-eluting stents (EES) have been shown to improve clinical outcomes compared with early-generation sirolimus-eluting (SES) and paclitaxel-eluting stents (PES) in patients undergoing percutaneous coronary intervention (PCI). Whether this benefit is maintained among patients with saphenous vein graft (SVG) disease remains controversial.

METHODS AND RESULTS:

We assessed cumulative incidence rates (CIR) per 100 patient years after inverse probability of treatment weighting to compare clinical outcomes. The pre-specified primary endpoint was the composite of cardiac death, myocardial infarction (MI), and target vessel revascularisation (TVR). Out of 12,339 consecutively treated patients, 288 patients (5.7%) underwent PCI of at least one SVG lesion with EES (n=127), SES (n=103) or PES (n=58). Up to four years, CIR of the primary endpoint were 58.7 for EES, 45.2 for SES and 45.6 for PES with similar adjusted risks between groups (EES vs. SES; HR 0.94, 95% CI: 0.55-1.60, EES vs. PES; HR 1.07, 95% CI: 0.60-1.91). Adjusted risks showed no significant differences between stent types for cardiac death, MI and TVR.

CONCLUSIONS:

Among patients undergoing PCI for SVG lesions, newer-generation EES have similar safety and efficacy to early-generation SES and PES during long-term follow-up to four years.

• Authors: Masanori Taniwaki, Lorenz Räber, Michael Magro, Bindu Kalesan, Yoshinobu Onuma, Giulio G Stefanini, Ron T van Domburg, Aris Moschovitis, Bernhard Meier, Peter Jüni, Patrick W Serruys, Stephan Windecker
• Journal: EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology (EuroIntervention) Vol. 9 Issue 12 Pg. 1432-40 ( 2014) ISSN: 1969-6213 [Electronic] France
• PMID: 24064377 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Cardiovascular Agents
• Everolimus
• Paclitaxel
• Sirolimus

Topics

• Aged
• Cardiovascular Agents (administration & dosage)
• Coronary Artery Bypass (adverse effects, mortality)
• Drug-Eluting Stents
• Everolimus
• Female
• Graft Occlusion, Vascular (diagnosis, etiology, mortality, therapy)
• Humans
• Male
• Middle Aged
• Myocardial Infarction (etiology)
• Netherlands
• Paclitaxel (administration & dosage)
• Percutaneous Coronary Intervention (adverse effects, instrumentation, mortality)
• Prosthesis Design
• Registries
• Risk Factors
• Saphenous Vein (transplantation)
• Sirolimus (administration & dosage, analogs & derivatives)
• Switzerland
• Time Factors
• Treatment Outcome