Comparison of stenting and balloon angioplasty for narrowings in aortocoronary saphenous vein conduits in place for more than five years.

Overview

To compare the 1 year outcome of Palmaz-Schatz stent implantation versus balloon angioplasty for treatment of obstructive lesions in saphenous vein grafts, we combined databases from the Palmaz-Schatz vein graft stent registry and the coronary angioplasty arm of the Coronary Angioplasty Versus Excisional Atherectomy Trial II (CAVEAT II) for comparison of baseline characteristics, procedural variables, in-hospital events and 1-year composite end point of death, Q-wave myocardial infarction, and repeat target vessel revascularization. De novo graft lesions not involving the ostia were treated with stent implantation in 377 patients and with coronary angioplasty in 156 patients. The patients were comparable in age, coronary risk profile, interval from bypass surgery (9 +/- 4 years), and reference vessel diameter. The in-hospital composite end point of death, myocardial infarction, and emergency revascularization was lower in the stent group (10%) than in the angioplasty cohort (17%) (p = 0.059). At 1 year, the patients in the stent group had a markedly lower incidence of the composite end point of death, myocardial infarction, or revascularization (23% vs 45%, p <0.001). In this nonrandomized comparison with balloon angioplasty, the treatment of lesions in saphenous vein grafts appears to be favorably influenced by Palmaz-Schatz stent implantation, in terms of in-hospital events and clinical restenosis at 1 year follow-up.