Immediate and Long-Term Results of Drug-Eluting Stents in Mammary Artery Grafts

• Published in: The American journal of cardiology 2015-12, Vol.116 (11), p.1695-1699
• Main Authors: Lozano, Iñigo, MD, Serrador, Ana, MD, Lopez-Palop, Ramon, MD, Lasa, Garikoitz, MD, Moreu, Jose, MD, Pinar, Eduardo, MD, de Prado, Armando Perez, MD, Alfonso, Fernando, MD, Jimenez Navarro, Manuel, MD, Quero, Monica Fernandez, MD, Pineda, Javier, MD, Martin Moreiras, Javier, MD, Garcia San Roman, Koldobika, MD, Lopez Minguez, Jose R., MD, Suarez Cuervo, Alfonso, MD, Gutierrez, Antonio, MD, Hernandez, Felipe, MD, Baz, Jose A., MD, Benedicto, Amparo, MD, Rumoroso, Jose R., MD, Gomez-Hospital, Joan A., MD, Serra, Vicens, MD, de la Torre, Jose M., MD, Ruiz-Quevedo, Valeriano, MD, Botas, Javier, MD, Fernandez, Jose A., MD, Sanchez-Recalde, Angel, MD
• Format: Article
• Language: English
• Subjects: Aged; Angina; Angina pectoris; Cardiovascular; Congestive heart failure; Diabetes mellitus; Diameters; Drug delivery; Drug-Eluting Stents; Everolimus - administration & dosage; Female; Grafting; Heart attacks; Humans; Immunosuppressive Agents - administration & dosage; Implants; Internal Mammary-Coronary Artery Anastomosis; Male; Medical records; Middle Aged; Mortality; Myocardial infarction; Occlusion; Paclitaxel; Paclitaxel - administration & dosage; Patients; Percutaneous treatment; Rapamycin; Sirolimus - administration & dosage; Sirolimus - analogs & derivatives; Stents; Surgical implants; Treatment Outcome; Veins & arteries
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2015.08.040

Percutaneous intervention of a coronary graft is the treatment of choice when the graft fails. The objective is to report the long-term results of drug-eluting stents (DES) in mammary artery grafts (MAG). Patients who had been treated with DES for MAG in 27 centers were selected. The baseline and procedural clinical data were included prospectively, and the follow-up was performed with the patients, families, and medical records. Two hundred and sixty-eight patients were included: age 65.5 ± 10.1 years, diabetes 47.8%, ejection fraction 55.5 ± 14.9%. Indication: stable angina 28.4%, unstable angina 38.1%, non–ST-elevation myocardial infarction 21.6%, ST-elevation myocardial infarction 5.3%, and heart failure 6.7%; 1.19 ± 0.59 stents/patient were implanted measuring 18.8 ± 8.8 mm in length and 2.68 ± 0.35 mm in diameter. Rapamycin was used in 78 cases (29.1%), paclitaxel in 77 (28.7%), everolimus in 70 (26.1%), zotarolimus in 34 (12.7%), and biolimus in 9 (3.4%). All cases were successful except for 1 in which the patient died 30 minutes after the procedure. There were no other inhospital events. After a follow-up of 41 months (Q25 : 23.7 to Q75 : 57.8), 24 patients (9%) died of heart-related causes and 20 (7.5%) of noncardiac causes. Repeat revascularization was necessary in 31 cases, and in 1 additional patient, there was total occlusion, which was not treated. These 32 patients represented 11.9% of the total. In conclusion, the implantation of DES in MAG shows very high procedural success and also low long-term event rates.