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

BACKGROUND: Compared to bare metal stents, first-generation drug-eluting stents (DES) significantly improved post-procedural outcomes in aortocoronary saphenous vein graft (SVG) lesions, but there is limited information on outcomes after use of second-generation DES. METHODS: We compared the outcomes of patients who received first-generation DES (n=82) with those who received second-generation DES (n=166) 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 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=65) 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 (20.00% vs. 20.91%, p=0.881), target lesion revascularization (16.13% vs. 20.00%, p=0.541), target vessel revascularization (20.63% vs. 23.16%, p=0.709), myocardial infarction (25.76% vs. 23.00%, p=0.684), and MACE (40.04% vs. 40.87%, p=0.764), 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 lesion subgroup.