title: Safety and clinical effectiveness of drug-eluting stents for saphenous vein graft intervention in older individuals: Results from the medicare-linked National Cardiovascular Data Registry(®) CathPCI Registry(®) (2005-2009).
abstract: OBJECTIVE
  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. © 2015 Wiley Periodicals, Inc.
authors.affiliation: Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina.
authors.forename: J Matthew
authors.initials: JM
authors.lastname: Brennan
authors.affiliation: Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Sketch
authors.affiliation: Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina.
authors.forename: David
authors.initials: D
authors.lastname: Dai
authors.affiliation: Department of Internal Medicine, Division of Cardiology, California Pacific Medical Center, San Francisco, California.
authors.forename: Marina
authors.initials: M
authors.lastname: Trilesskaya
authors.affiliation: Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Wesam
authors.initials: W
authors.lastname: Al-Hejily
authors.affiliation: Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Rao
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Brilakis
authors.affiliation: Department of Medicine, Division of Cardiology, Denver Veterans Affairs Medical Center, Denver, Colorado.
authors.forename: John C
authors.initials: JC
authors.lastname: Messenger
authors.affiliation: Department of Clinical Informatics, Division of Cardiology, Sutter Pacific Heart Centers, San Francisco, California.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Shaw
authors.affiliation: Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Anstrom
authors.affiliation: Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Douglas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D009203:Myocardial Infarction / Q000175:diagnosis / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D012042:Registries; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
keywords: bare metal stents; drug-eluting stents; outcomes; saphenous vein grafts