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New-generation drug eluting stent vs. bare metal stent in saphenous vein graft - 1 year outcomes by a propensity score ascertainment (SVG Baltic Registry)

Wojciech Wańha, Maksymilian Mielczarek, Tomasz Roleder, Szymon Ładziński, Marek Milewski, Natasza Gilis-Malinowska, Michał Chmielecki, Dariusz Ciećwierz, Witold Bachorski, Piotr Kunik, Agata Trznadel, Klaudia Męcka, Alicja Genc, Rafał Januszek, Piotr Pączek, Artur Dziewierz, Stanisław Bartuś, Marcin Gruchała, Grzegorz Smolka, Dariusz Dudek, Eliano Pio Navarese, Andrzej Ochała, Miłosz Jaguszewski, Wojciech Wojakowski
International Journal of Cardiology 2019 April 11

BACKGROUND: Data regarding the efficacy of the percutaneous coronary intervention (PCI) with new-designed drug-eluting stent (new-DES) vs. bare metal stent (BMS) of saphenous vein grafts (SVG) stenosis is scarce. The primary objective was to compare one-year clinical outcomes of PCI in stenosis of SVG using new-DES vs. BMS in a real-world population.

METHODS AND RESULTS: We carried out a multi-center registry comparing new-DES with BMS in all consecutive patients undergoing PCI of SVG. The primary composite endpoint was major adverse cardiac and cerebrovascular events (MACCE) at 1 year. This observation included 792 consecutive patients (mean age 69 ± 8.9y), treated with either new-DES (n = 379, 47.9%) or BMS (n = 413, 52.1%). Among patients treated with new-DES compared with BMS, there was a lower risk of MACCE (21.4% vs. 28.3%, HR = 0.69, 95% CI 0.50-0.95, p = 0.025) as well as myocardial infarction (MI) (6.3% vs. 12.1%; HR 0.49, 95% CI 0.30-0.82, p = 0.005) at 1 year. After propensity score adjustment, the similar, significant reduction in MACCE and MI was observed in favor of new-DES (HR 0.66, 95% CI 0.46-0.96, p = 0.030; and HR 0.53, 95% CI 0.31-0.92, p = 0.020, respectively).

CONCLUSION: In patients undergoing PCI of SVG, the use of new-DES is associated with a reduced 1-year rate of MACCE and MI compared to BMS.


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