Mehmet Serkan ÇETİN, Müjgan TEK, Aksüyek Savaş ÇELEBİ

Safen Ven Greft Perkütan Koroner Girişimlerinde İlaç Kaplı Stentlerle Çıplak Metal Stentlerin Uzun Dönem Sonuçları: Tek Merkez

Amaç: Safen ven greft lezyonlarında ilaç kaplı ya da çıplak metal stent kullanımıyla ilgili sonuçlar tartışmalıdır. Bizim çalışmamızın amacı çıplak metal stent ve ilaç kaplı stent kullanılan safen ven greft perkütan koroner girişim sonuçlarını karşılaştırmaktı. Gereç ve Yöntem: Merkezimizde Ocak 2013-Aralık 2017 tarihleri arasında ilaç kaplı veya çıplak metal stent ile safen ven greft perkütan koroner girişim yapılmış tüm hastalar retrospektif olarak değerlendirildi. Miyokard infarktüsü, hedef damar revaskülarizasyonu ve ölümü içeren majör kardi- yak olaylar açısından karşılaştırma yapıldı. Bulgular: Çalışmaya 92 hasta dahil edildi. 72 hastada ilaç kaplı stent ve 20 hastada çıplak metal stent kullanılmıştı. Ortalama takip süresi 29 (0-66) aydı. İlaç kaplı stent ve çıplak metal stent arasında myokard infarktüsü, ölüm ve hedef damar revaskülarizasyonu açısından fark yoktu. Olaysız sağka- lım oranı her iki grupda benzerdi. (%71.3 ilaç kaplı stent grubu, %71.8 çıplak metal stent grubu, p =0.660). Sonuç: Gerçek yaşam verilerimizde safen ven greft perkütan koroner girişimlerinde ilaç kaplı stentlerle çıplak metal stentler arasında uzun dönem klinik sonuçlarda anlamlı bir fark yoktu. Bununla birlikte, daha fazla vaka ve uzun süreli takipler gereklidir

Long-Term Outcomes of Percutaneous Coronary Intervention with Drug-Eluting Stents Versus Bare-Metal Stents in Saphenous Vein Graft Lesions: A Single Center Experience

Objective: There is controversery data about the use of drug-eluting stents versus bare-metal stents in saphenous vein graft lesions. Our purpose was to compare the outcomes of patients receiving drug-eluting stents or bare-metal stents in saphenous vein graft percutaneous coronary interventions. Material and Method: All patients undergoing saphenous vein graft percutaneous coronary intervention with a drug-eluting stent or bare-metal stent alone from January 2013 to December 2017 at our center were assessed retrospectively. Major adverse cardiac events including myocardial infarction, target vessel revascularization and death were recorded at follow up period. Results: Ninety two patients included the study. Of these,72 patiens received a drug eluting stent and 20 patients had a bare metal stent. The median follow-up was 29 (range 0-66) months. There were no different outcomes for myocardial infarction, death and target vessel revascularization between drug eluting stent and bare metal stent. The rate of major adverse cardiac event -free survival was %71.3 in the drug eluting stent group and %71.8 in the bare metal stent group (p =0.660). Conclusion: There was no significant difference in long-term outcomes between drug eluting stent and bare metal stent in saphenous vein graft percutaneous coronary interventions in our real world experience. However, more cases and long-term follow-up are warranted.

PDF

___

1. Goldman S, Zadina K, Moritz Tet et al. Long-term patency of saphenous vein and left internal mam- mary artery grafts after coronary artery bypass surgery: results from a Department of Veterans Af- fairs Cooperative Study. J Am Coll Cardiol 2004: 44: 2149-56.
2. Loop FD. A 20-year experience in coronary artery reoperation. Eur Heart J 1989; 10(suppl H): 78-84.
3. Bonaa KH, Mannsverk J, Wiseth R et al. Drug- eluting or bare-metal stents for coronary artery di- sease. N Eng J Med 2016; 375: 1242-52.
4. Vermeersch P, Agostoni P, Verheye S et al. Incre- ased late mortality after sirolimus-eluting stents versus bare-metal stents in diseased saphenous vein grafts: results from the randomized DELA- YED RRISC trial. J Am Coll Cardiol 2007; 50: 261-7.
5. Brilakis ES, Lichtenwalter C, Abdel-karim AR et al. Continued benefit from paclitaxel-eluting com- pared with bare-metal stent implantation in saphe- nous vein graft lesions during long-term follow-up of the SOS (stenting of saphenous vein grafts) trial. JACC Cardiovasc Interv 2011; 4: 176-82.
6. Mehilli J, Pache J, Abdel-Wahab M et al. Drug- eluting versus bare-metal stents in saphenous vein graft lesions (ISAR-CABG): a randomised control- led superiority trial. Lancet 2011; 378: 1071-8.
7. Brilakis ES, Edson R, Bhatt DL et al. Drug-eluting stents versus bare-metal stents in saphenous vein grafts: a double-blind, randomised trial. Lancet 2018; 19; 391: 1997-2007.
8. Kheiri B, Osman M, Abdalla A, Ahmed S, Bac- huwa G, Hassan M. The short- and long-term out- comes of percutaneous intervention with drug- eluting stent vs bare-metal stent in saphenous vein graft disease: An updated meta-analysis of all ran- domized clinical trials. Clin Cardiol 2018; 41: 685- 92.
9. Ha FJ, Nogic J, Montone RA, Cameron JD, Nerle- kar N, Brown AJ. Drug eluting versus bare metal stents for percutaneous coronary intervention of saphenous vein graft lesions: An updated meta- analysis of randomized controlled trials. Cardio- vasc Revasc Med 2018; 3. doi: 10.1016/j.carrev.2018.03.025.
10. Yahagi K, Kolodgie FD, Otsuka F et al. Pathophy- siology of native coronary vein graft and in-stent atherosclerosis. Nat Rev Cardiol 2016; 13: 79-98.