Use of drug-eluting stents in saphenous vein aortocoronary bypass graft lesions: A critical appraisal

The use of drug-eluting stents (DES) in aortocoronary saphenous vein bypass grafts (SVGs) remains controversial. We reviewed 14 published studies that examined the outcomes after DES implantation in SVG lesions. All studies, except two, were retrospective, and reported follow-up for approximately 1 year or less. Ten of the 14 studies were single-center. Six studies (5 retrospective and 1 prospective), including a total of 711 patients, compared DES with bare metal stents: 2 studies included paclitaxel-eluting stents, 2 studies included sirolimus-eluting stents, and 2 studies included both. Four of five retrospective comparative studies showed lower incidence of major adverse cardiac events in the DES group during short-term follow-up (6-12 months), mainly due to a reduction in target vessel revascularization (TVR) (3 of 4 studies had high rates of follow-up angiography). In the only published prospective, randomized controlled study, patients receiving DES had lower incidence of TVR at 6 months, but during longer follow-up (median 32 months), they had similar incidence of TVR and higher mortality. A large, multicenter, randomized controlled clinical trial is needed to clarify the role of DES in the percutaneous treatment of SVG lesions.