JACC: DES bests BMS for heart bypass surgeries
Coronary bypass surgery may carry less risk of serious complications if drug-eluting stents (DES) that suppress cell growth are used in the procedure rather than bare-metal stents (BMS), according to a study published online in January in the Journal of the American College of Cardiology.
"We wanted to see if one type of stent was superior in reducing the incidence of re-narrowing of the vein graft," said the study’s lead author Emmanouil Brilakis, MD, assistant professor of internal medicine at University of Texas (UT) Southwestern Medical Center in Dallas. "Stented vein grafts have a very high risk of re-narrowing – sometimes up to 50 percent when bare metal stents are used.
"Drug-eluting stents could provide a solution to this problem, but limited clinical results have been reported to date. The drug-eluting stents examined in our study are coated with a medication called [Boston Scientific’s Taxus] paclitaxel, which inhibits cell growth,” Brilakis said.
In the study, researchers examined 80 patients, roughly half of whom had vein grafts with DES and the other half who had the same procedure with BMS.
Researchers found that 51 percent of patients with the bare-metal stent had re-narrowing of the vein graft over several months compared with 9 percent of the drug-eluting stent group. In addition, 28 percent of patients who had a bare-metal stent required another procedure to treat the same blockage, while only 5 percent of patients who had the drug-eluting stent did.
Some previous studies have indicated that patients receiving DES in saphenous vein grafts may not reduce the risk of re-narrowing and may be associated with increased risk of death, according to Brilakis.
"Our findings suggest that drug-eluting stents are a better choice than bare-metal stents for this type of procedure," Brilakis said. "Patients receiving paclitaxel-eluting stents in our study were significantly less likely to have recurrence of their graft blockage and to require repeat procedures. The rates of death were similar in both study groups, although our study was not designed to detect differences in mortality."
The authors said that now hope to repeat the study in an expanded group of patients, which would provide important data to determine definitively the efficacy and safety of each kind of stent.
"We wanted to see if one type of stent was superior in reducing the incidence of re-narrowing of the vein graft," said the study’s lead author Emmanouil Brilakis, MD, assistant professor of internal medicine at University of Texas (UT) Southwestern Medical Center in Dallas. "Stented vein grafts have a very high risk of re-narrowing – sometimes up to 50 percent when bare metal stents are used.
"Drug-eluting stents could provide a solution to this problem, but limited clinical results have been reported to date. The drug-eluting stents examined in our study are coated with a medication called [Boston Scientific’s Taxus] paclitaxel, which inhibits cell growth,” Brilakis said.
In the study, researchers examined 80 patients, roughly half of whom had vein grafts with DES and the other half who had the same procedure with BMS.
Researchers found that 51 percent of patients with the bare-metal stent had re-narrowing of the vein graft over several months compared with 9 percent of the drug-eluting stent group. In addition, 28 percent of patients who had a bare-metal stent required another procedure to treat the same blockage, while only 5 percent of patients who had the drug-eluting stent did.
Some previous studies have indicated that patients receiving DES in saphenous vein grafts may not reduce the risk of re-narrowing and may be associated with increased risk of death, according to Brilakis.
"Our findings suggest that drug-eluting stents are a better choice than bare-metal stents for this type of procedure," Brilakis said. "Patients receiving paclitaxel-eluting stents in our study were significantly less likely to have recurrence of their graft blockage and to require repeat procedures. The rates of death were similar in both study groups, although our study was not designed to detect differences in mortality."
The authors said that now hope to repeat the study in an expanded group of patients, which would provide important data to determine definitively the efficacy and safety of each kind of stent.