Drug-eluting stents are disappointing in bypass grafts - sometimes!

While drug-eluting stents are effective in keeping open bypassed heart veins that aren't too diffuse (filled with cholesterol plaque), a new study by cardiologists at Jefferson Medical College shows that they fare less well in keeping open bypassed veins with longer blockages.

The researchers suggest that doctors think twice before inserting the drug-coated stents in such extensively diseased bypassed grafts.

The researchers looked at the success of drug-eluting stents in bypassed vein grafts and found that long-term success was dependent on the healthiness of the vessel. Lead researcher Nicholas J. Ruggiero II, M.D., a fellow in cardiovascular diseases, will present the results at the American College of Cardiology's 56th Annual Scientific Session on Monday, March 26, from 4 to 4:50 pm. (Abstract 916-214).

Seventy patients--61 men and nine women with a mean age of 70 years--were studied. Twenty eight (40 percent) of the patients had diabetes. The researchers divided the patients into those with focal disease (less than 30 millimeters of disease or fewer than three blockages in one vessel) or diffuse (extensive) disease (more than 30 millimeters of disease or three or more lesions in a single bypass).

Focal disease is considered to be less of a problem in the veins of patients who have undergone heart bypass surgery. Diffuse disease means that the artery is much more clogged and therefore at greater risk of re-clogging.

Thirty nine percent of the patients had diffuse disease. After one year, the researchers found that 84 percent of these patients were free of clinical restenosis (re-clogging) or disease in the drug-eluted stent bypasses. In patients with focal blockage, only three percent needed an additional procedure to treat restenosis after one year. In contrast, in patients with diffuse disease, 37 percent needed additional procedures to treat restenosis.

"To date, drug-eluting stents haven't been adequately studied in patients who previously underwent bypass surgery" explains Michael Savage, M.D., director, Cardiac Catheterization Laboratory at Thomas Jefferson University Hospital, Philadelphia.

"This research provides a bit of sobering news for interventional cardiologists and their patients," adds Dr. Savage, who is also associate professor of Medicine, Jefferson Medical College of Thomas Jefferson University. "The long-term outcome in diffusely diseased bypass grafts remains poor despite the use of drug-eluting stents. Physicians should carefully weigh the options before inserting stents into them."

http://www.jeffersonhospital.org