DIVA: No Difference With BMS, DES Use in Patients With Severe SVG Lesions

There was no difference between bare metal stents (BMS) and drug-eluting stents (DES) in patients undergoing percutaneous coronary interventions of de novo saphenous vein bypass graft (SVG) lesions, according to the results of the DIVA trial presented on Aug. 26 as part of the ESC Congress 2017.

Researchers, led by Emmanouil S. Brilakis, MD, PhD, FACC, randomized 599 patients (mean age 69/99 percent male) to received BMS or DES. All patients had similar baseline characteristics and were followed for a median of 2.7 years. The primary endpoint was the 12-month incidence of target vessel failure (TVF, defined as the composite of cardiac death, target vessel myocardial infarction or target vessel revascularization). Secondary endpoints included all-cause death and cardiac death, myocardial infarction during follow-up, target lesion revascularization and incremental cost-effectiveness of DES relative to BMS.

Overall results showed the incidence of TVF based on adjudicated results was 17 percent at 12 months in the DES group and 19 percent in the BMS group (p = 0.67). Researchers noted no significant differences between the DES and BMS groups in the components of the primary endpoint or stent thrombosis. Over the entire length of follow-up, the incidence of TVF using adjudicated results for the first year and reported results thereafter was 37 percent in the DES group and 34 percent in the BMS group (p = 0.46).

In presenting the study, Brilakis said limitations included the fact that nearly all patients were men. Additionally, the study ended before reaching its revised enrollment target. However, he said more patients still participated in the study than initially planned. Moving forward, he said the findings suggest the need for novel strategies for treatment of severe SVG lesions. 

Keywords: ESC Congress, ESC2017, Drug-Eluting Stents, Saphenous Vein, Cost-Benefit Analysis, Percutaneous Coronary Intervention, Myocardial Infarction, Coronary Artery Bypass, Stents, Metals, Thrombosis

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