Original title: Safety and effectiveness of drug-eluting versus bare-metal stents in saphenous vein bypass graft percutaneous coronary interventions: insights from the Veterans Affairs CART program. Reference: Aggarwal V et al. J Am Coll Cardiol. 2014;64:1825-1836.

This study retrospectively evaluated 2471 receiving after saphenous vein graft (SVG) PCI between October and September 2011. Outcomes were compared using propensity score matching between 895 patients treated with conventional bare metal stents (BMS) and 901 patients treated with drug eluting stents (DES).

The use of DES compared to BMS increased from 50% in 2008 to 69% in 2011. Peri procedural complications were low for both groups (2.8% with BMS vs 2.3% with DES; p=0 .54) but the long term showed differences.

At median follow up of 2.8 years, the use of DES was associated with lower mortality rates after propensity score matching (HR 0.72; CI 95% 0.57 to 0.89). Despite the difference in mortality, infarction rate was similar in both groups and these results were no different when looking at the different DES patients received. 

Conclusion

In this great cohort, increasing use of DES during SVG PCI was observed, compared to the use of BMS. Long term follow up showed DES were safe and effective. 

Editorial Comment

In the absence of a randomized study to confirm these data, the lower mortality rate observed with the use of DES in this study should be interpreted with caution, since it cannot be explained by a lower infarction rate.

Another limitation to this study is the lack of information on restenosis and revascularization, where we should see a greater advantage of DES.

SOLACI