Saphenous vein grafts (SVGs) are commonly used for CABG surgery, but they are prone to occlusion and show high rates of failure. Strategies to treat SVG stenosis include percutaneous coronary intervention (PCI) with stent implantation. A new study reveals that patients who receive drug-eluting stents (DES) for PCI of SVG lesions have similar clinical outcomes to patients who receive bare-metal stents (BMS).

Previous efforts to compare the performance of the two types of stents resulted in conflicting results owing to study limitations. “There was equipoise as to whether DES would provide better outcomes than BMS in SVGs,” explains Emmanouil Brilakis, corresponding author of the study. The double-blind, randomized trial included 597 patients, with at least one de-novo, clinically significant SVG lesion, who were randomly assigned to receive DES or BMS for PCI. After 12 months, no significant difference was found between the two groups for the primary combined end point of cardiac death, target-vessel myocardial infarction, or target-vessel revascularization, with an incidence of 17% in the DES group and 19% in the BMS group (HR 0.92, 95% CI 0.63–1.34, P = 0.70). The risks of stent thrombosis and stroke were also similar between the two groups.

“We were surprised by those findings, as we were anticipating that DES would be superior to BMS as has been shown for multiple other coronary lesion types,” says Brilakis. The specific pathophysiology of atherosclerosis in a graft contributes to the lesion-specific efficiency of DES for PCI and supports the use of alternative options to treat graft failure. “Given the overall poor outcomes after SVG stenting, treating the native coronary arteries supplying the same myocardial territory instead may be advantageous,” concludes Brilakis.