VEST III

External Stenting and Disease Progression in Saphenous Vein Grafts Two Years After Coronary Artery Bypass Grafting: A Multicenter Randomized Trial

Study design & primary objectives

NCT02511834 (clinicaltrials.gov reference #)

Trial period: Oct/2015 - Oct/2019

Sample size: N=184

Participating centers:

  1. Krankenhaus der Barmherzigen Bruder, Trier, Germany
  2. German Heart Centre Berlin Clinic, Berlin, Germany
  3. West-German Heart Center Essen University, Essen, Germany
  4. Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, Germany
  5. Uniklinik Köln, Cologne, Germany
  6. John Radcliffe hospital, Oxford, UK
  7. Blackpool Victoria Hospital, Blackpool, UK
  8. Royal Papworth Hospital, Cambridge, UK
  9. University Hospital, Southampton, UK
  10. University Hospitals, Bristol, UK
  11. Medizinische Universität, Vienna, Austria
  12. Medical University, Innsbruck, Austria
  13. Sheba MC, Ramat Gan, Israel
  14. Rambam MC, Haifa, Israel


Principal investigator:  Prof. David Taggart, Oxford, UK & Prof. Ivar Friedrich, Trier, Germany.

Design:

184 patients undergoing isolated CABG, using an internal mammary artery graft and at least 2 additional SVG, were enrolled to the VEST III study.
One SVG was randomized to an external stent (VEST), while one non-stented SVG served as the control. 
The primary endpoint was SVG Fitzgibbon patency scale (FPS) assessed by angiography and the secondary endpoint was SVG intimal hyperplasia (IH) assessed by intravascular ultrasound (IVUS) in a pre-specified subgroup at 2 years. 


Primary Objective: 
To investigate the effect of external stenting on the progression of SVG disease 2 years post CABG.

Results summary

1. Baseline grafting parameters such as coronary artery diameter, graft’s length, TTFM and pulsatility index were well balanced between the VEST and control groups - (Table 1)

2. Fitzgibbon Patency Scale (FPS): FPS was significantly improved in stented versus non-stented SVG, with FPS I, II and III rates, respectively, 66.7% vs 54.9%, 27.8% vs 34.3% and 5.5% vs 10.8% (Odds Ratio 2.02, P=0.03) – (Table 2)

3. FPS was inversely related to SVG minimal lumen diameter (MLD), with FPS I, II and III SVG having an average MLD of 2.62mm, 1.98mm and 1.32mm, respectively (P<0.05) – (Table 2)

4. The externally stented SVG’s also showed significant reductions in mean IH area (22.5%; P<0.001) and thickness (23.5%; P<0.001) – (Table 3)

Main Conclusions

Two years after CABG, external stenting of saphenous grafts leads to improved Fitzgibbon patency and significantly reduces SVG disease progression by reducing both the area and thickness of intimal hyperplasia.

VEST III Publications

Name

Link

External Stenting and Disease Progression in Saphenous Vein Grafts Two Years After Coronary Artery Bypass Grafting: A Multicenter Randomized Trial

VEST III


Tables

Table 1: Baseline grafting parameters of study grafts

 
Table 2: Angiographic findings 2 years after CABG

 
Table 3: IVUS based measurements at 2 years post CABG