Background: Saphenous vein graft (SVG) intervention is associated with a significantly increased rate of periprocedural complications and late clinical and angiographic restenosis. We sought to examine the efficacy and safety of Sirolimus-Eluting Stents (SES, Cypher^TM) in SVG intervention compared to the bare metal stents (BMS).
Methods: A total 49 patients (pts) with 52 SVG lesions who underwent standard PCI with SES (SES group) were compared with 99 pts with 124 SVG lesions with BMS (BMS group). All pts received distal protection devices (DPD) during SVG intervention and were treated with either bivalirudin or heparin alone. The periprocedural, in-hospital, 30-day and 6 month clinical outcomes in both groups were compared.
Results: Baseline clinical and procedural characteristics were balanced between 2 groups except SES group had more ostial lesions (22.4% vs. 6.5%, P=0.002) and restenosis lesions (18.0% vs. 6.5%, P=0.01). The pts in SES group had lower in-hospital non-Q-wave acute myocardial infarction (non-Q wave AMI; 8.3% vs. 27.3%, P=0.008), major CK-MB elevation (3X normal; 6.3% vs. 21.2%, P=0.03) and a trend toward shorter length of intensive care unit stay (0.6 day vs. 1.3 day, P=0.07). At 30 days, there was trend toward less non-Q wave AMI in the SES group (8.7% vs. 20.7%, P=0.08) but this benefit was not maintained at 6 months follow-up. The incidence of stent thrombosis was similar between 2 groups up to 6 months.
Conclusion: Use of SES in patients undergoing SVG intervention with DPD is clinically safe and feasible with lower ischemic events up to 1 month only as compared with BMS.