Monday, 27 August 2012

Abstract

Purpose: Trials have shown improved short-term outcome with drug-eluting stents (DES) vs bare metal stents (BMS) in Saphenous vein graft (SVG) PCI, primarily by reducing target vessel revascularization (TVR). We assessed the outcomes in patients undergoing SVG stent implantation comparing DES vs BMS using a propensity matched analysis. Methods: Clinical information was analysed from a prospective database on 512 patients who underwent SVG PCI between 2003-2010 293 patients underwent PCI with BMS and 219 with DES Propensity scores representing the estimated probabilities of patients receiving either DES or BMS were developed based on 18 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), defined as death, myocardial infarction (MI), stroke and TVR out to a median of 3.3 years (IQR: 2.1-4.1) 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 followup. MACE was driven by in-stent restenosis in both groups and the difference between groups was due to increased TVR in the BMS group (Figure 1). There was no difference in death, MI or stroke between the stent types. Propensity matched 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 mortality (HR: 1.08 95% CI: 0.77-1.68). (Figure Presented) Conclusions: 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.