Drug-eluting stents (DES) should be the preferred option for patients undergoing PCI for de-novo saphenous vein graft lesions, experts say, as a randomised study confirms they are superior to bare-metal metal stents (BMS) in this group.
Published in the Lancet the ISAR-CABG trial of 610 patients with de-novo saphenous vein graft lesions found those receiving DES had a 36% lower risk of major adverse events compared with those randomised to BMS.
Some 15% of patients receiving DES met the primary endpoint of death, MI or target lesion revascularisation at one year, compared with 22% of patients receiving BMS.
This difference was driven by a 51% reduction in target lesion revascularisation with DES compared with BMS.
“The reduction in target lesion revascularisation was the result of the increased antirestenotic efficacy of DES in saphenous vein grafts, a finding corroborated by the significant reduction in angiographic restenosis with this type of stent,” the authors wrote.
However, no significant differences were found between DES and BMS regarding all-cause mortality, MI or stent thrombosis.
“The findings of this trial support further broadening of the indication for the use of DES in patients with coronary artery disease to include patients with lesions in saphenous vein grafts,” the authors wrote.
An accompanying editorial noted results from observational studies of DES implanted for symptomatic vein graft disease had been mixed.
While neointima proliferation was the main contribution to restenosis after stenting in native coronary vessels, in saphenous vein grafts, thrombus formation, cellular hyperplasia and atherosclerotic progression were the main drivers, the editorial said.
Lancet 2011; doi:10.1016/S0140-6736(11)61255-5 (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61340-8/fulltext#