Abstract 9364: Drug Eluting Stents Appear Superior to Bare Metal Stents for Vein Graft Pci in a Propensity Matched Cohort
Background: Research trials have shown improved short-term outcome with drug-eluting stents (DES) over bare metal stent (BMS) in Saphenous vein graft (SVG) PCI, primarily by reducing target vessel revascularization (TVR) for In-Stent Restenosis (ISR).
Because of the high event rates in these patients it is not clear if these benefits are maintained long term. We compared the outcomes in patients undergoing SVG stent implantation treated with DES or BMS, over a prolonged follow-up period using a propensity matched analysis.
Methods: Clinical information was analysed from a prospective database on 512 patients who underwent PCI for SVG lesions between 2003 and 2010. 293 patients had PCI with BMS and 219 with DES. Propensity scores representing the estimated probabilities of patients receiving either DES or BMS were developed based on 15 observed baseline covariates in a logistic regression model with stent type as the dependent variable. The nearest-neighbour-matching algorithm with Greedy 5-1 Digit Matching was used to produce two patient cohorts of 219 patients each balanced for baseline factors.
We assessed major adverse cardiac events (MACE) ) out to a median of 3.3 years (IQR: 2.1-4.1)
MACE defined as •All Cause mortality •Myocardial infarction (MI)
•Target vessel revascularisation (TVR)
•Stroke Results There was a significant difference in MACE between the two groups in favour of DES (17.9% DES v 31.2% BMS group [P=0.04] over the 5-year follow-up.
MACE was driven by ISR in both groups and the difference between groups was due to increased TVR in the BMS group. There was no difference in death, MI or stroke.(Figure 1)
Adjusted Cox analysis confirmed a decreased risk of MACE for DES compared with BMS 0.75 (95% confidence intervals 0.52-0.94) with no difference in the hazard of all cause mortality (HR: 1.08 95% CI: 0.77-1.68).
Conclusion: In our cohort of patients who had PCI for treatment of SVG disease the use of DES resulted in lower MACE rate compared to BMS over a 5-year follow-up.
- © 2013 by American Heart Association, Inc.