Abstract 17960: Drug-Eluting Stents vs. Bare-Metal Stents for the Treatment of Svg Lesions
Background: Although DES have been shown to be superior to BMS in barely all clinical and angiographic scenarios, long-term safety and efficacy of these devices in SVG lesions has yet to be proven. We sought to compare the incidence of major adverse clinical events (MACE) in non-selected patients (pts) with SVG lesions treated with DES or BMS.
Methods: The present analysis included pts with SVG lesions treated in two institutions — one private and the other public — by the same team of interventional cardiologists between May 2006 and January 2009. In our country, public health system does not reimburse the use of DES, therefore pts treated in the public hospital received BMS. Conversely, DES was the default strategy in the private institution. Except for the type of stent, all the other devices and drugs were equally available in both hospitals (including protection devices and IIb-IIIa inhibitors) at operator's discretion. We only excluded pts with acute MI and those with ISR lesions. The primary goal was the comparison of MACE (cardiac death, MI and TLR) between groups in the long-term follow-up (FU).
Results: 308 pts (209 treated with DES and 99 with BMS) were enrolled. Average patient and graft age were 68 and 10.9 years, with no difference between groups. Apart from DM, which was more prevalent in the BMS cohort (52% vs. 31.6%, p<0.01), other baseline clinical and angiographic characteristics were similar. Angiographic success was achieved in >97% of the cases in both groups (p=0.6). Long term FU (mean 22 months) was obtained in 98% of the cases. MACE rate did not statically differ between cohorts (17.2% for DES vs. 18.2% for BMS, p=0.8) despite a trend to higher TLR in the BMS group (7.2% vs. 3.3%, p= 0.1). Definite/probable stent thrombosis was similar in both groups (2.3% for DES vs. 2% for BMS, p = 0.7).
Conclusions: In the long term FU, patients with SVG lesions treated with DES had similar MACE rate and tended to present less frequent TLR. Of note, no safety concerns were observed among pts receiving DES when compared with those treated with BMS.
- © 2010 by American Heart Association, Inc.