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AHA-ATVB: No Early Benefit Seen to Drug-Eluting Stents Over CABG


CHICAGO, April 23 -- Drug-eluting stents may not offer the early advantage over coronary artery bypass grafts seen with bare-metal devices, researchers reported here.

CHICAGO, April 23 -- Drug-eluting stents may not offer the early advantage over coronary artery bypass grafts (CABG) seen with bare-metal devices, researchers reported here.

In a single-center observational study, drug-eluting stents and CABG had similar 30-day and three-year outcomes for coronary patients, said James M. Wilson, M.D., of the Texas Heart Institute at St. Luke's Episcopal Hospital in Houston, and colleagues.

The study, presented at the American Heart Association's Conference on Arteriosclerosis, Thrombosis, and Vascular Biology here, represented one of the first reports on outcomes of drug-eluting stents versus bypass grafting.

In previous studies, bare-metal stents had better outcomes at one year that then eroded to equivalence at three years and disadvantage compared with CABG at long-term follow-up, Dr. Wilson said.

"It's a little worrisome that we don't have that early advantage we had with the bare-metal stents," he said. "This surprised us."

Dr. Wilson and colleagues looked at in-hospital and three-year follow-up data from 1,598 unselected coronary-artery patients who underwent isolated primary revascularization by drug-eluting stents or CABG.

Patients were case matched by procedure propensity score to ensure similar patient characteristics between groups. For both, the average age was 64, about 7% had an urgent procedure, about 30% had diabetes, and about 75% had more than one diseased vessel.

Early, 30-day major adverse cardiac and cerebrovascular event findings were:

  • Similar overall (3.78% CABG versus 5.01% DES, P=NS).
  • Not significantly different for myocardial infarction between groups (1.67% versus 2.22%, P=NS).
  • Significantly lower stroke rate with drug eluting stents (1.11% versus 0.11%, P

Continued follow-up in this and other studies are needed to show how drug-eluting stents stack up to surgery long term, he added.

"What I think is going to be most interesting is when we extend our survival curves out to five to 7.5 years, and maybe those curves start to separate," Dr. Wilson said. "Right now all we can say is they are close enough to each other that we can't make any predictions."

"This is the type of study that will be very helpful," commented Sidney Smith, M.D., of the University of South Florida in Tampa and a past president of the American Heart Association, who was not involved in the study.

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