TY - JOUR
T1 - Safety and clinical effectiveness of drug-eluting stents for saphenous vein graft intervention in older individuals
T2 - Results from the medicare-linked National Cardiovascular Data Registry® CathPCI Registry® (2005-2009)
AU - Brennan, J. Matthew
AU - Sketch, Michael H.
AU - Dai, David
AU - Trilesskaya, Marina
AU - Al-Hejily, Wesam
AU - Rao, Sunil V.
AU - Brilakis, Emmanouil
AU - Messenger, John C.
AU - Shaw, Richard E.
AU - Anstrom, Kevin J.
AU - Peterson, Eric D.
AU - Douglas, Pamela S.
N1 - Publisher Copyright:
© 2015 Wiley Periodicals, Inc.
PY - 2016/1/1
Y1 - 2016/1/1
N2 - Objectives To evaluate the safety of drug-eluting stents (DES) when treating patients with failing saphenous vein grafts (SVG). Background DES reduce target vessel revascularization in patients with failing SVGs; however, compared with bare metal stents (BMS), DES have been variably associated with increased mortality. Methods Clinical records from National Cardiovascular Data Registry® CathPCI Registry® (49,325 older individuals [≥65 years] who underwent SVG stenting 2005-2009) were linked to Medicare claims to create a longitudinal record. Death, myocardial infarction (MI), and urgent revascularization with DES versus BMS were evaluated to 3 years using propensity matching (PM). Results were stratified by clinical presentation (acute coronary syndrome [ACS], non-ACS), previous lesion treatment (in-stent, de novo), and graft segment (aortic, body, distal anastomosis). Results In this older cohort (median age, 75 years), acute presentations were prevalent (ACS, 69%; TIMI flow <3, 45%), and adverse clinical outcomes were common by 3 years (death, 24.5%; MI, 14.6%; urgent revascularization, 29.5%). Among DES patients (n = 31,403), 3-year mortality was lower (vs. BMS) (22.7% vs. 28.0%, P < 0.001; PM hazard ratio [HR] 0.87, 95% confidence interval 0.83-0.91), and no difference was observed in the adjusted risk for MI (PM HR 0.97, 0.91 to 1.03) or urgent revascularization (PM HR 1.04, 0.99-1.08). These findings were independent of clinical presentation, previous lesion treatment, and graft segment (P interaction, ns). Conclusions In this large SVG PCI cohort, all-cause mortality was lower among those receiving DES, and no difference in MI or urgent revascularization was observed to 3 years.
AB - Objectives To evaluate the safety of drug-eluting stents (DES) when treating patients with failing saphenous vein grafts (SVG). Background DES reduce target vessel revascularization in patients with failing SVGs; however, compared with bare metal stents (BMS), DES have been variably associated with increased mortality. Methods Clinical records from National Cardiovascular Data Registry® CathPCI Registry® (49,325 older individuals [≥65 years] who underwent SVG stenting 2005-2009) were linked to Medicare claims to create a longitudinal record. Death, myocardial infarction (MI), and urgent revascularization with DES versus BMS were evaluated to 3 years using propensity matching (PM). Results were stratified by clinical presentation (acute coronary syndrome [ACS], non-ACS), previous lesion treatment (in-stent, de novo), and graft segment (aortic, body, distal anastomosis). Results In this older cohort (median age, 75 years), acute presentations were prevalent (ACS, 69%; TIMI flow <3, 45%), and adverse clinical outcomes were common by 3 years (death, 24.5%; MI, 14.6%; urgent revascularization, 29.5%). Among DES patients (n = 31,403), 3-year mortality was lower (vs. BMS) (22.7% vs. 28.0%, P < 0.001; PM hazard ratio [HR] 0.87, 95% confidence interval 0.83-0.91), and no difference was observed in the adjusted risk for MI (PM HR 0.97, 0.91 to 1.03) or urgent revascularization (PM HR 1.04, 0.99-1.08). These findings were independent of clinical presentation, previous lesion treatment, and graft segment (P interaction, ns). Conclusions In this large SVG PCI cohort, all-cause mortality was lower among those receiving DES, and no difference in MI or urgent revascularization was observed to 3 years.
KW - bare metal stents
KW - drug-eluting stents
KW - outcomes
KW - saphenous vein grafts
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U2 - 10.1002/ccd.25979
DO - 10.1002/ccd.25979
M3 - Article
C2 - 26153480
AN - SCOPUS:84954367414
SN - 1522-1946
VL - 87
SP - 43
EP - 49
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 1
ER -