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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

1113 — Use and Effectiveness of Drug-Eluting versus Bare Metal Stents in Saphenous Vein Bypass Graft Percutaneous Coronary Interventions

Tsai TT, and Maddox TM, Denver VAMC/U of Colorado Denver; Nallamothu BK, Ann Arbor VAMC/University of Michigan; Stanislawski MAAdams JC, and Box TL, Denver VAMC; Ho PM, Denver VAMC/U of Colorado Denver; Rao SV, Durham VAMC/Duke University; Rumsfeld JS, Denver VAMC/U of Colorado Denver; Brilakis ES, VA North Texas/UT Southwestern

Objectives:
Although the advantages of drug eluting stents (DES) versus bare metal stents (BMS) in native coronary artery disease is well documented, little is known about the use and outcomes of DES versus BMS in saphenous vein graft (SVG) percutaneous coronary interventions (PCI) in Veterans.

Methods:
From the National VA CART program database of 78 catheterization laboratories, we identified all VA patients undergoing SVG PCI (n = 2,636). Based on a propensity score to receive a DES, we identified a matched cohort of 920 patients who received a DES to 920 patients who received a BMS (n = 1,840 total) during an index SVG PCI between October 2004 and September 2010. Kaplan-Meier analyses were performed to determine the association of DES vs BMS use and follow-up myocardial infarction, revascularization, and death.

Results:
SVG PCI represented 7.3% of the total PCI volume (2,636 of 36,256 patients). Of these, 1,615 (61.2%) were treated with a DES, and embolic protection devices were successfully used in 32.5% of patients. In the propensity matched cohort, the 2-year rate of death was significantly lower among patients who received a DES versus BMS (15.4% vs 20.3%, p <0.001). However, the 2-year MI and revascularization rates were not significantly different in the DES versus BMS groups respectively (13.4% vs 15.8%, p = 0.06 and 25.1% vs 24.7%, p = 0.66).

Implications:
In a large national SVG-PCI registry, DES compared to BMS use was associated with lower rates of death but similar rates of revascularization and myocardial infarction.

Impacts:
There continues to be conflicting data regarding the outcomes after DES implantation in SVG’s. In Veterans undergoing SVG PCI, DES’s are used in 61% of cases and do not appear to be associated with an increase in adverse events and may be associated with improved survival. Further studies, including a randomized clinical trial in VA (DIVA) evaluating DES vs BMS in SVG’s are ongoing.


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