We read with great interest the important and timely study by Lee et al, who compared sirolimus-eluting stents (SES) and paclitaxel-eluting stents (PES) for the treatment of saphenous vein graft lesions in the Southern California Registry. The investigators concluded that SES and PES had similar 1-year clinical outcomes. Although their interpretation of the study findings is correct, we would like to propose an alternative interpretation: that PES may provide superior results compared with SES in saphenous vein grafts, but this was not demonstrated in the investigators’ study because of small sample size. Indeed, the hazard ratio for target vessel revascularization was 2.54 (95% confidence interval 0.84 to 7.72, p = 0.09) in favor of PES.
As Lee et al highlighted, there is a discrepancy in the results of the 2 prospective randomized trials of drug-eluting stents in saphenous vein grafts. The Reduction of Restenosis in Saphenous Vein Grafts With Cypher Sirolimus-Eluting Stent (RRISC) trial showed no benefit and increased risk with SES, whereas the Stenting of Saphenous Vein Grafts (SOS) trial showed benefit with PES and similar risk, even during long-term follow-up. Similarly favorable results with PES were seen in the Moderate Vein Graft Lesion Stenting With the Taxus Stent and Intravascular Ultrasound (VELETI) trial, and an analysis of the Taxus Peri-Approval Registry: A Multicenter Safety Surveillance (ARRIVE) program. Whether PES are truly superior to SES (and also the second-generation drug-eluting stents) remains to be proved.
References
- 1. Lee M.S., Hu P.P., Aragon J., Shah A.P., Oyama J., Dhoot J., Iqbal Z., Jones N., Penny W., Tobis J., Mahmud E., and French W.: Comparison of sirolimus-eluting stents with paclitaxel-eluting stents in saphenous vein graft intervention (from a Multicenter Southern California Registry). Am J Cardiol 2010; 106: pp. 337-341
- 2. Vermeersch P., Agostoni P., Verheye S., Van den Heuvel P., Convens C., Van den Branden F., and Van Langenhove G.: Increased late mortality after sirolimus-eluting stents versus bare-metal stents in diseased saphenous vein grafts: results from the randomized DELAYED RRISC trial. J Am Coll Cardiol 2007; 50: pp. 261-267
- 3. Brilakis E.S., Lichtenwalter C., de Lemos J.A., Roesle M., Obel O., Haagen D., Saeed B., Gadiparthi C., Bissett J.K., Sachdeva R., Voudris V.V., Karyofillis P., Kar B., Rossen J., Fasseas P., Berger P., and Banerjee S.: A randomized controlled trial of a paclitaxel-eluting stent versus a similar bare-metal stent in saphenous vein graft lesions the SOS (Stenting of Saphenous Vein Grafts) trial. J Am Coll Cardiol 2009; 53: pp. 919-928
- 4. Rodes-Cabau J., Bertrand O.F., Larose E., Dery J.-P., Rinfret S., Bagur R., Proulx G., Nguyen C.M., Cote M., Landcop M.-C., Boudreault J.-R., Rouleau J., Roy L., Gleeton O., Barbeau G., Noel B., Courtis J., Dagenais G.R., Despres J.-P., and DeLarochelliere R.: Comparison of plaque sealing with paclitaxel-eluting stents versus medical therapy for the treatment of moderate nonsignificant saphenous vein graft lesions. Circulation 2009; 120: pp. 1978-1986
- 5. Brilakis E.S., Lasala J.M., Cox D.A., Berger P.B., Bowman T.S., Starzyk R.M., and Dawkins K.D.: Outcomes after implantation of the TAXUS paclitaxel-eluting stent in saphenous vein graft lesions: results from the ARRIVE (TAXUS Peri-Approval Registry: A Multicenter Safety Surveillance) program. J Am Coll Cardiol Intv 2010; 3: pp. 742-750
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