Comparison of outcomes of coronary stenting versus conventional coronary angioplasty in the department of Veterans Affairs medical centers

Although the short-term benefits of stent deployment have been established, less is known about lang-term outcomes. This study compares short- and lon g-term outcomes in veterans undergoing stenting and conventional coronary a ngioplasty. We used Department of Veterans Affairs databases to identify 27 ,224 veterans who had undergone percutaneous coronary intervention (PCI) in Veterans Affairs medical centers between October 1994 and September 1999. Patients were classified according to whether they had acute myocardial inf arction (AMI) as the principal diagnosis. Baseline characteristics were sim ilar in the stent and conventional groups. In AMI, hospital mortality was 2 .9% for those with stents and 4.8% for those who underwent conventional cor onary angioplasty (p < 0.0001), whereas for paitents without AMI, hospital mortality was similar (1.2% vs 1.4%, p = 0.12). For AMI, same-admission byp ass surgery rates were lower in the stent group (0.7% vs 3.2%, p < 0.0001) and in the group without AMI (1.2% vs 3.3%, p < 0.0001). Two-year survival was better for stenting in veterans with (90% vs 88%, p = 0.006) and withou t (92% vs 91%, p = 0.008) AMI. For AMI, 2-year rehospitalization rates for PCI (10% vs 13%, p < 0.0001), coronary artery bypass surgery (4% vs 6%, p < 0.0001), and unstable angina (17% vs 23%) were lower for those who had ste nting. In the no-AMI group, 2-year rehospitalization rates for PCI (14% vs 17%, p < 0.0001), coronary artery bypass surgery (5% vs 8%, p < 0.0001), an d unstable angina (22% vs 29%, p < 0.0001) were lower in the stent group. V eterans who underwent stenting had lower hospital mortality, reduced rates of same-admission bypass surgery, marginally better survival, and lower rat es of rehospitalization than their counterparts who head conventional coron ary angioplasty. (C) 2001 by Excerpta Medica, Inc.