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BASKET-SAVAGE: DES superior to BMS for revascularization of saphenous vein grafts
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In patients requiring revascularization of saphenous vein grafts, drug-eluting stents were more effective than bare-metal stents, according to the results of the BASKET-SAVAGE trial.
Researchers randomly assigned 173 patients with saphenous vein graft disease (median age, 72 years to receive PCI with BMS (Liberté, Boston Scientific; n = 84) or a paclitaxel-eluting stent (Taxus Liberté, Boston Scientific; n = 89). They presented their findings at the European Society of Cardiology Congress.
The patients had received their saphenous vein grafts after CABG a median of 13 years prior, according to the researchers. Glycoprotein IIb/IIIa inhibitors were used in 74% of cases, and distal protection devices were used in 66% of cases.
The primary endpoint was MACE, defined as cardiac death, nonfatal MI or target vessel revascularization, at 12 months. Other endpoints included definite or probable stent thrombosis and major bleeding up to 36 months.
At 12 months, MACE occurred in 2.3% of the DES group vs. 17.9% of the BMS group (HR = 0.15; P < .001), Raban V. Jeger, MD, from University Hospital, Basel, Switzerland, reported, noting that the difference was driven by TVR (DES, 0%; BMS, 11.9%; HR = 0.04; P < .001) and nonfatal MI (DES, 2.3%; BMS, 11.9%; HR = 0.24; P = .025).
Raban V. Jeger
In patients followed to 36 months, MACE continued to be lower in the DES group (12.4% vs. 29.8%; HR = 0.33; P = .0012), according to the researchers.
Rates of cardiac death, noncardiac death, major bleeding and stent thrombosis did not differ between the groups at 12 months or long-term.
“This is currently the largest trial with long-term outcome data comparing these two types of stents in saphenous vein graft disease, and will reassure clinicians about the use of DES for this specific indication,” Jeger said in a press release. “DES should remain the standard of care in patients with [saphenous vein graft] lesions undergoing [PCI].” – by Erik Swain
Reference:
Jeger RV, et al. Hot Line: Coronary artery disease and stenting. Presented at: European Society of Cardiology Congress; Aug. 27-31, 2016; Rome.
Disclosure: The study was funded in part by Boston Scientific Germany. Jeger reports no relevant financial disclosures.
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Roxana Mehran, MD, FACC, FACP, FCCP, FESC, FAHA, FSCAI
Once again, we see that a DES is doing extremely well; in this case, in patients requiring saphenous vein graft intervention. It was good to see this issue reexamined.
Limitations include that the study was stopped early because of slow enrollment, and that a first-generation DES was used. Despite that, both early and long-term outcomes were in favor of DES over BMS. The efficacy of DES, even in vein grafts, is confirmed above and beyond over BMS.
I don’t think these results will change clinical practice, as DES are already very much in use in every scenario unless a patient is completely unable to take dual antiplatelet therapy. Even with that, given what we know from the LEADERS FREE results, we’re using DES in almost every indication.
Despite all the data we have, there are less and less on saphenous vein graft interventions. It’s nice to see investigators are still researching that area even though it is less of an issue than it used to be. Better primary and secondary prevention has led to vein grafts being kept completely open or closed, so vein graft intervention has become a more uncommon procedure in the cath lab.
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