VA Study Shows DES May be Superior to BMS in SVG-PCI

The use of drug-eluting stents (DES) during stenosis of saphenous vein graft (SVG) percutaneous coronary interventions (PCI) has become increasingly widespread, with long-term follow-up observations suggesting greater safety and efficacy of the device then its bare metal stent (BMS) counterpart, according to according to a study published Oct. 20 in the Journal of the American College of Cardiology.

Led by Vikas Aggarwal, MD, MPH, VA Eastern Colorado Health Care System, Denver, CO, the study gathered data from a national cohort of 2,471 patients undergoing SVG-PCI at Veterans Affairs hospitals between 2008 and 2011. The authors examined differences in procedural outcomes and late safety endpoints between DES and BMS, particularly myocardial infarction and all-cause mortality. Results showed that DES were used in 1,549 (63 percent) of SVG-PCI patients, with its use progressively increasing with each calendar year (50 percent in 2008 to 69 percent in 2011).

Additionally, incidences of procedural complications were low and comparable in both groups (2.8 percent among BMS vs. 2.3 percent among DES, p = 0.54). Long-term follow-up (>2 years) also showed that the use of DES was associated with lower mortality compared to BMS (HR 0.72; 95 percent CI 0.57 to 0.89) and similar rates of MI (HR 0.94; 95 percent CI 0.71 to 1.24) in the propensity-matched cohort.

The authors conclude that as the medical community patiently awaits the results of larger randomized trials to better establish the efficacy of drug-eluting stent use in SVG-PCI, the findings of the study “are reassuring and helpful to clinicians in stent selection during SVG-PCI.”

As Christodoulos Stefanadis, MD, Professor of Cardiology, Athens Medical School, Athens, Greece, writes in a commenting essay, “to supplement current knowledge about late DES safety in SVG-PCI, this well-conducted study takes advantage of the knowledge of the vital status in a large population treated with DES or BMS for SVG-PCI.” He adds that, “This observation supports the safety of second-generation DES in SVG-PCI, consistent with clinical observations that these stents have an enhanced safety profile in native vessel PCI and with imaging observations of a favorable healing response.”

“Such real-world registries are important for evaluating whether clinical practice is, indeed, moving on the right track and for providing large-scale observations that corroborate and supplement findings from randomized studies,” writes Stefanadis.

Keywords: Myocardial Infarction, Follow-Up Studies, Greece, Drug-Eluting Stents, Saphenous Vein, Schools, Medical, Colorado, Constriction, Pathologic, Stents, Percutaneous Coronary Intervention

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