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.
abstract: BACKGROUND
  Stenosis of saphenous vein grafts (SVGs) after coronary artery bypass grafting (CABG) is common and often requires percutaneous coronary interventions (PCI) for treatment. However, data for the effectiveness of drug-eluting stents (DES) versus bare-metal stents (BMS) in SVG-PCI are unclear.
  
  
  OBJECTIVE
  This study sought to examine the association between DES versus BMS used during SVG PCI and clinical outcomes in the national Veterans Affairs integrated healthcare system.
  
  
  METHODS
  We studied a national cohort of 2,471 post-CABG veterans undergoing SVG-PCI between 2008 and 2011 at all Veterans Affairs hospitals and compared clinical outcomes of between those receiving DES and BMS. Clinical outcomes included procedural complications, myocardial infarction (MI), and all-cause mortality. Comparisons were made in a propensity-matched cohort using Cox proportional hazards regression models.
  
  
  RESULTS
  DES were used in 1,549 SVG-PCI patients (63%) and the use of DES increased progressively with each calendar year (50% in 2008 to 69% in 2011). Incidence of procedural complications was low and comparable in both groups (2.8% among BMS vs. 2.3% among DES patients; p = 0.54). During long-term (>2 years) follow-up, use of DES was associated with lower mortality than BMS (hazard ratio [HR]: 0.72; 95% confidence interval [CI]: 0.57 to 0.89) and similar rates of MI (HR: 0.94; 95% CI: 0.71 to 1.24) in the propensity-matched cohort.
  
  
  CONCLUSIONS
  In a national cohort of veterans, we observed widespread and increasing use of DES during SVG-PCI. In long-term follow-up, compared with BMS, DES use was safe and effective in SVG-PCI patients.
authors.affiliation: VA Eastern Colorado Health Care System, Denver, Colorado; University of Colorado, Denver Anschutz Medical Campus, Aurora, Colorado; Colorado Cardiovascular Outcomes Research Consortium, Denver, Colorado.
authors.forename: Vikas
authors.initials: V
authors.lastname: Aggarwal
authors.affiliation: VA Eastern Colorado Health Care System, Denver, Colorado; University of Colorado, Denver Anschutz Medical Campus, Aurora, Colorado; Colorado Cardiovascular Outcomes Research Consortium, Denver, Colorado.
authors.forename: Maggie A
authors.initials: MA
authors.lastname: Stanislawski
authors.affiliation: VA Eastern Colorado Health Care System, Denver, Colorado; University of Colorado, Denver Anschutz Medical Campus, Aurora, Colorado; Colorado Cardiovascular Outcomes Research Consortium, Denver, Colorado.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Maddox
authors.affiliation: University of Michigan, Ann Arbor, Michigan.
authors.forename: Brahmajee K
authors.initials: BK
authors.lastname: Nallamothu
authors.affiliation: VA Eastern Colorado Health Care System, Denver, Colorado; University of Colorado, Denver Anschutz Medical Campus, Aurora, Colorado; Colorado Cardiovascular Outcomes Research Consortium, Denver, Colorado.
authors.forename: Gary
authors.initials: G
authors.lastname: Grunwald
authors.affiliation: VA Eastern Colorado Health Care System, Denver, Colorado.
authors.forename: Jill C
authors.initials: JC
authors.lastname: Adams
authors.affiliation: VA Eastern Colorado Health Care System, Denver, Colorado; University of Colorado, Denver Anschutz Medical Campus, Aurora, Colorado; Colorado Cardiovascular Outcomes Research Consortium, Denver, Colorado.
authors.forename: P Michael
authors.initials: PM
authors.lastname: Ho
authors.affiliation: Durham VA Medical Center, Durham, North Carolina.
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Rao
authors.affiliation: Mater Private Hospital, Dublin, Ireland.
authors.forename: Ivan P
authors.initials: IP
authors.lastname: Casserly
authors.affiliation: VA Eastern Colorado Health Care System, Denver, Colorado; University of Colorado, Denver Anschutz Medical Campus, Aurora, Colorado; Colorado Cardiovascular Outcomes Research Consortium, Denver, Colorado.
authors.forename: John S
authors.initials: JS
authors.lastname: Rumsfeld
authors.affiliation: VA North Texas Health Care System, Dallas, Texas; University of Texas Southwestern Medical School, Dallas, Texas.
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
authors.affiliation: VA Eastern Colorado Health Care System, Denver, Colorado; University of Colorado, Denver Anschutz Medical Campus, Aurora, Colorado; Colorado Cardiovascular Outcomes Research Consortium, Denver, Colorado; Institute for Health Research, Kaiser Permanente, Denver, Colorado. Electronic address: thomas.tsai@va.gov.
authors.forename: Thomas T
authors.initials: TT
authors.lastname: Tsai
mesh_terms: D000368:Aged; D001705:Bioprosthesis / Q000009:adverse effects; D001026:Coronary Artery Bypass / Q000379:methods*; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation*; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans
chemical_list: D008670:Metals
keywords: bare-metal stent; drug-eluting stent; percutaneous coronary intervention; repeat revascularization; saphenous venous graft