Long-Term Results After Drug-Eluting Versus Bare-Metal Stent Implantation in Saphenous Vein Grafts: Randomized Controlled Trial

被引:5
|
作者
Fahrni, Gregor [1 ]
Farah, Ahmed [2 ,3 ]
Engstrom, Thomas [4 ]
Galatius, Soren [5 ,6 ]
Eberli, Franz [7 ]
Rickenbacher, Peter [1 ]
Conen, David [1 ,8 ]
Mueller, Christian [1 ]
Pfister, Otmar [1 ]
Twerenbold, Raphael [1 ]
Coslovsky, Michael [1 ]
Cattaneo, Marco [1 ]
Kaiser, Christoph [1 ]
Mangner, Norman [9 ,10 ]
Schuler, Gerhard [10 ]
Pfisterer, Matthias [1 ]
Moebius-Winkler, Sven [10 ,11 ]
Jeger, Raban V. [1 ]
机构
[1] Univ Hosp, Basel, Switzerland
[2] Klinikum Westfalen, Dortmund, Germany
[3] Cent Clin, Bad Berka, Germany
[4] Rigshosp, Copenhagen, Denmark
[5] Bispebjerg Hosp, Copenhagen, Denmark
[6] Gentofte Univ Hosp, Hellerup, Denmark
[7] Triemli Hosp, Zurich, Switzerland
[8] McMaster Univ, Populat Hlth Res Inst, Hamilton, ON, Canada
[9] Tech Univ Dresden, Herzzentrum Dresden, Dresden, Germany
[10] Univ Leipzig, Heart Ctr, Leipzig, Germany
[11] Univ Jena, Jena, Germany
来源
JOURNAL OF THE AMERICAN HEART ASSOCIATION | 2020年 / 9卷 / 20期
基金
瑞士国家科学基金会;
关键词
bare-metal stent; coronary artery bypass; drug-eluting stent; saphenous vein graft;
D O I
10.1161/JAHA.120.017434
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Efficacy data on drug-eluting stents (DES) versus bare-metal stents (BMS) in saphenous vein grafts are controversial. We aimed to compare DES with BMS among patients undergoing saphenous vein grafts intervention regarding long-term outcome. Methods and Results In this multinational trial, patients were randomized to paclitaxel-eluting or BMS. The primary end point was major adverse cardiac events (cardiac death, nonfatal myocardial infarction, and target-vessel revascularization at 1 year. Secondary end points included major adverse cardiac events and its individual components at 5-year follow-up. One hundred seventy-three patients were included in the trial (89 DES versus 84 BMS). One-year major adverse cardiac event rates were lower in DES compared with BMS (2.2% versus 16.0%, hazard ratio, 0.14; 95% CI, 0.03-0.64,P=0.01), which was mainly driven by a reduction of subsequent myocardial infarctions and need for target-vessel revascularization. Five-year major adverse cardiac event rates remained lower in the DES compared with the BMS arm (35.5% versus 56.1%, hazard ratio, 0.40; 95% CI, 0.23-0.68,P<0.001). A landmark-analysis from 1 to 5 years revealed a persistent benefit of DES over BMS (hazard ratio, 0.33; 95% CI, 0.13-0.74,P=0.007) in terms of target-vessel revascularization. More patients in the BMS group underwent multiple target-vessel revascularization procedures throughout the study period compared with the DES group (DES 1.1% [n=1] versus BMS 9.5% [n=8],P=0.013). Enrollment was stopped before the target sample size of 240 patients was reached. Conclusions In this randomized controlled trial with prospective long-term follow-up of up to 5 years, DES showed a better efficacy than BMS with sustained benefits over time. DES may be the preferred strategy in this patient population. Registration URL:; Unique identifier: NCT00595647.
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页数:12
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