Long-Term Outcomes with First- vs. Second-Generation Drug-Eluting Stents in Saphenous Vein Graft Lesions

Background: As compared with bare metal stents, first-generation drug-eluting stents (DES) improved post-procedural outcomes in aortocoronary saphenous vein graft (SVG) lesions, but there is limited information on outcomes after use of second-generation DES in SVGs. Methods: We compared the outcomes of patients who received first- (n=81) with those who received second-generation (n=166) DES in SVG lesions at our institution between 2006 and 2013. Major adverse cardiac events (MACE) were defined as the composite of all-cause death, myocardial infarction, and target vessel revascularization. Results: Mean age was 66.0 +/- 8.1 years and 97.6% of the patients were men. Mean SVG age was 11.1 +/- 0.4 years. First-generation DES were sirolimus-eluting (n=17) and paclitaxel-eluting (n=64) stents. Second-generation DES were everolimus-eluting (n=115) and zotarolimus-eluting (n=51) stents. Median follow-up was 41 months. At 2-years post-procedure, patients with first-and second-generation DES had similar rates of death (20.91% vs. 20.27%, P=0.916), target lesion revascularization (16.39% vs. 20.00%, P=0.572), target vessel revascularization (20.97% vs. 23.16%, P=0.747), myocardial infarction (26.15% vs. 23.00%, P=0.644), and MACE (43.5% vs. 40.87%, P=0.707), respectively. Conclusions: Outcomes with first-and second-generation DES in SVGs are similar. Novel stent designs are needed to further improve the clinical outcomes in this challenging patient and lesion subgroup. (C) 2015 Wiley Periodicals, Inc.