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Comparison of Sirolimus-Eluting Stents With Paclitaxel-Eluting Stents in Saphenous Vein Graft Intervention (from a Multicenter Southern California Registry)

      This study was designed to compare the safety and efficacy of sirolimus-eluting stents (SESs) to paclitaxel-eluting stents (PESs) in percutaneous intervention of saphenous vein graft (SVG) lesions. SVGs develop atherosclerosis at high rates and often require repeat revascularization. Percutaneous intervention with drug-eluting stents has become the preferred method of revascularization due to higher restenosis with bare metal stents and increased morbidity and mortality with repeat coronary artery bypass grafting. We sought to compare the rate of major adverse cardiac events and stent thrombosis between SESs and PESs in patients undergoing SVG intervention. A multicenter analysis of 172 patients with SVG lesions treated with SESs or PESs was performed. The 30-day and 1-year clinical outcomes of 102 patients receiving SESs were compared to those of 70 patients receiving PESs. There was no significant difference in baseline demographic, angiographic, and procedural characteristics between the SES and PES treatment groups. There was no statistical difference in major adverse cardiac events at 30 days and at 1 year (hazard ratio [HR] 1.58, 95% confidence interval [CI] 0.77 to 3.23, log-rank p = 0.21). There was also no difference in survival (HR 1.28, 95% CI 0.39 to 4.25, log-rank p = 0.69) or target vessel revascularization (HR 2.54, 95% CI 0.84 to 7.72, log-rank p = 0.09). In conclusion, this multicenter analysis of real-world patients demonstrated that SESs and PESs have similar clinical outcomes when used in SVG intervention.
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      Linked Article

      • Could Paclitaxel-Eluting Stents Be Superior to Sirolimus-Eluting Stents for the Treatment of Saphenous Vein Graft Lesions?
        American Journal of CardiologyVol. 106Issue 9
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          We read with great interest the important and timely study by Lee et al,1 who compared sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) for the treatment of saphenous vein graft lesions in the Southern California Registry. The investigators concluded that SES and PES had similar 1-year clinical outcomes. Although their interpretation of the study findings is correct, we would like to propose an alternative interpretation: that PES may provide superior results compared with SES in saphenous vein grafts, but this was not demonstrated in the investigators' study because of small sample size.
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