Safety and Effectiveness of Drug-Eluting Versus Bare-Metal Stents in Saphenous Vein Bypass Graft Percutaneous Coronary Interventions: Insights From the National Veterans Administration CART Program

Study Questions:

What is the comparative effectiveness and safety of drug-eluting stents (DES) versus bare-metal stents (BMS) in patients receiving saphenous vein graft–percutaneous coronary intervention (SVG-PCI)?

Methods:

The investigators studied a national cohort of 2,471 post–coronary artery bypass grafting (CABG) veterans undergoing SVG-PCI between 2008 and 2011 at all Veterans Affairs hospitals, and compared clinical outcomes between those receiving DES and BMS. Clinical outcomes included procedural complications, myocardial infarction (MI), and all-cause mortality. Comparisons were made in a propensity-matched cohort using Cox proportional hazards regression models.

Results:

DES were used in 1,549 (63%) SVG-PCI patients and its use increased progressively with each calendar year (50% in 2008 to 69% in 2011). Incidence of procedural complications was low and comparable in both groups (2.8% among BMS vs. 2.3% among DES, p = 0.54). During long-term (>2 years) follow-up, use of DES was associated with lower mortality compared to BMS (hazard ratio [HR], 0.72; 95% confidence interval [CI], 0.57-0.89) and similar rates of MI (HR, 0.94; 95% CI, 0.71-1.24) in the propensity-matched cohort.

Conclusions:

The authors concluded that compared to BMS, DES use was safe and effective in SVG-PCI.

Perspective:

This study reports that DES were used twice as often as BMS during SVG-PCI, and that DES use increased over time compared to BMS. There was lower all-cause mortality and similar MI rates with DES compared to BMS on longitudinal follow-up after propensity matching. Therefore, the safety of DES versus BMS was observed in patients undergoing SVG-PCI. The results of the ongoing DIVA (Drug-Eluting Stents vs. Bare Metal Stents In Saphenous Vein Graft Angioplasty; NCT01121224) trial will provide additional insight on the efficacy of DES use in SVG-PCI.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Aortic Surgery

Keywords: Myocardial Infarction, Follow-Up Studies, Metals, Drug-Eluting Stents, Saphenous Vein, Confidence Intervals, Coronary Artery Bypass, Angioplasty, United States Department of Veterans Affairs, Stents, Percutaneous Coronary Intervention


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