Michael Tesfaldet T, Abdel-karim Abdul-rahman R, Papayannis Aristotelis, Lichtenwalter Christopher, de Lemos James A, Obel Owen, Addo Tayo, Roesle Michele, Haagen Donald, Rangan Bavana V, Saeed Bilal, Bissett Joseph K, Sachdeva Rajesh, Voudris Vassilios V, Karyofillis Panagiotis, Kar Biswajit, Rossen James, Fasseas Panayotis, Berger Peter B, Banerjee Subhash, Brilakis Emmanouil S
Veteran Affairs North Texas Healthcare System, Dallas, Texas, USA.
J Invasive Cardiol. 2011 Jun;23(6):216-9.
The Stenting of Saphenous Vein Grafts (SOS) trial demonstrated a reduction in clinical and angiographic adverse events with paclitaxel-eluting stents (PES) compared to bare-metal stents (BMS) in saphenous vein graft (SVG) lesions, but the rate of recurrent adverse events has not been described.
We performed a post hoc, landmark analysis to evaluate the risk of event recurrence following a non-fatal initial event among the SOS trial patients (pts).
During a median follow-up of 35 months, the 80 pts enrolled in SOS experienced a total of 78 major cardiovascular events (MACE): 51 in the BMS group and 27 in PES group. No MACE were found in 28 pts (35%) while 52 pts (65%) had at least one event. The initial event was death in 13 pts (16%). Among the 39 pts whose initial event was not fatal, 12 (31%) had one or more subsequent MACE (50% of which were definitely related to the study SVG). The mean and median number of MACE per patient was significantly higher in patients receiving BMS versus PES (1.3 ± 1.2 and 1 ± 1.26 versus 0.6 ± 0.7 and 1 ± 0.825, p = 0.005 and p = 0.008, respectively). The rate of a second MACE following an initial event was 17% in the PES group and 37% in the BMS group (p = 0.24). Ten of 12 pts with recurrent events had received a BMS (83%).
Pts undergoing SVG stenting had a high rate of recurrent events after an initial non-fatal event. These events were often related to the target vessel and most occurred in pts who had received a BMS, further supporting the benefit of PES over BMS in SVG lesions.
大隐静脉移植血管支架置入术（SOS）试验表明，在大隐静脉移植血管（SVG）病变中，与裸金属支架（BMS）相比，紫杉醇洗脱支架（PES）可减少临床和血管造影不良事件，但复发性不良事件的发生率尚未见报道。
我们进行了一项事后的标志性分析，以评估SOS试验患者（pts）发生非致命性初始事件后事件复发的风险。
在中位随访35个月期间，SOS试验纳入的80例患者共发生78次主要心血管事件（MACE）：BMS组51次，PES组27次。28例患者（35%）未发生MACE，而52例患者（65%）至少发生1次事件。初始事件为死亡的有13例患者（16%）。在初始事件非致命的39例患者中，12例（31%）发生了1次或更多次后续MACE（其中50%肯定与研究中的SVG相关）。接受BMS的患者与接受PES的患者相比，每位患者的MACE平均和中位数显著更高（分别为1.3±1.2和1±1.26对0.6±0.7和1±0.825，p = 0.005和p = 0.008）。初始事件后第二次MACE的发生率在PES组为17%，在BMS组为37%（p = 0.24）。12例复发事件患者中有10例接受了BMS（83%）。
接受SVG支架置入术的患者在初始非致命事件后复发性事件发生率较高。这些事件通常与靶血管相关，且大多数发生在接受BMS的患者中，进一步支持了PES在SVG病变中优于BMS的益处。
