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Brennan JM, Al-Hejily W, Dai D, Shaw RE, Trilesskaya M, Rao SV, Brilakis ES, Anstrom KJ, Messenger JC, Peterson ED, Douglas PS, Sketch MH. Three-Year Outcomes Associated With Embolic Protection in Saphenous Vein Graft Intervention. Circ Cardiovasc Interv 2015; 8:e001403. [DOI: 10.1161/circinterventions.114.001403] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Information is limited on contemporary use and outcomes of embolic protection devices (EPDs) in saphenous vein graft interventions.
Methods and Results—
We formed a longitudinal cohort (2005–2009; n=49 325) by linking National Cardiovascular Data Registry CathPCI Registry to Medicare claims to examine the association between EPD use and both procedural and long-term outcomes among seniors (65+ years), adjusting for clinical factors using propensity and instrumental variable methodologies. Prespecified high-risk subgroups included acute coronary syndrome and de novo or graft body lesions. EPDs were used in 21.2% of saphenous vein grafts (median age, 75; 23% women) and were more common in acute coronary syndrome (versus non–acute coronary syndrome; 22% versus 19%), de novo (versus restenotic; 22% versus 14%), and graft body lesions (versus aortic and distal anastomosis; 24% versus 20% versus 8%, respectively). EPDs were associated with a slightly higher incidence of procedural complications, including no reflow (3.9% versus 2.8%;
P
<0.001), vessel dissection (1.3% versus 1.1%;
P
=0.05), perforation (0.7% versus 0.4%;
P
=0.001), and periprocedural myocardial infarction (2.8% versus 1.8%;
P
<0.001). By 3 years, death, myocardial infarction, and repeat revascularization occurred in 25%, 15%, and 30% of cases, respectively. EPD use was associated with a similar adjusted risk of death (propensity score–matched hazard ratio, 0.96; 95% confidence interval, 0.91–1.02), myocardial infarction (propensity score–matched hazard ratio, 1.00; 95% confidence interval, 0.93–1.09), and repeat revascularization (propensity score–matched hazard ratio, 1.02; 95% confidence interval, 0.96–1.08) in the overall cohort and high-risk subgroups.
Conclusions—
In this contemporary cohort, EPDs were used more commonly among patients with high-risk clinical indications, yet there was no evidence of improved acute- or long-term outcomes. Further prospective studies are needed to support routine EPD use.
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Affiliation(s)
- J. Matthew Brennan
- From the Duke Clinical Research Institute, Durham, NC (J.M.B., W.A.-H., D.D., S.V.R., K.J.A., E.D.P., P.S.D., M.H.S.); Sutter Pacific Heart Centers, San Francisco, CA (R.E.S.); Carolina Pacific Medical Center, San Francisco, CA (M.T.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (E.S.B.); and Denver Veterans Affairs Medical Center, CO (J.C.M.)
| | - Wesam Al-Hejily
- From the Duke Clinical Research Institute, Durham, NC (J.M.B., W.A.-H., D.D., S.V.R., K.J.A., E.D.P., P.S.D., M.H.S.); Sutter Pacific Heart Centers, San Francisco, CA (R.E.S.); Carolina Pacific Medical Center, San Francisco, CA (M.T.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (E.S.B.); and Denver Veterans Affairs Medical Center, CO (J.C.M.)
| | - David Dai
- From the Duke Clinical Research Institute, Durham, NC (J.M.B., W.A.-H., D.D., S.V.R., K.J.A., E.D.P., P.S.D., M.H.S.); Sutter Pacific Heart Centers, San Francisco, CA (R.E.S.); Carolina Pacific Medical Center, San Francisco, CA (M.T.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (E.S.B.); and Denver Veterans Affairs Medical Center, CO (J.C.M.)
| | - Richard E. Shaw
- From the Duke Clinical Research Institute, Durham, NC (J.M.B., W.A.-H., D.D., S.V.R., K.J.A., E.D.P., P.S.D., M.H.S.); Sutter Pacific Heart Centers, San Francisco, CA (R.E.S.); Carolina Pacific Medical Center, San Francisco, CA (M.T.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (E.S.B.); and Denver Veterans Affairs Medical Center, CO (J.C.M.)
| | - Marina Trilesskaya
- From the Duke Clinical Research Institute, Durham, NC (J.M.B., W.A.-H., D.D., S.V.R., K.J.A., E.D.P., P.S.D., M.H.S.); Sutter Pacific Heart Centers, San Francisco, CA (R.E.S.); Carolina Pacific Medical Center, San Francisco, CA (M.T.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (E.S.B.); and Denver Veterans Affairs Medical Center, CO (J.C.M.)
| | - Sunil V. Rao
- From the Duke Clinical Research Institute, Durham, NC (J.M.B., W.A.-H., D.D., S.V.R., K.J.A., E.D.P., P.S.D., M.H.S.); Sutter Pacific Heart Centers, San Francisco, CA (R.E.S.); Carolina Pacific Medical Center, San Francisco, CA (M.T.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (E.S.B.); and Denver Veterans Affairs Medical Center, CO (J.C.M.)
| | - Emmanouil S. Brilakis
- From the Duke Clinical Research Institute, Durham, NC (J.M.B., W.A.-H., D.D., S.V.R., K.J.A., E.D.P., P.S.D., M.H.S.); Sutter Pacific Heart Centers, San Francisco, CA (R.E.S.); Carolina Pacific Medical Center, San Francisco, CA (M.T.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (E.S.B.); and Denver Veterans Affairs Medical Center, CO (J.C.M.)
| | - Kevin J. Anstrom
- From the Duke Clinical Research Institute, Durham, NC (J.M.B., W.A.-H., D.D., S.V.R., K.J.A., E.D.P., P.S.D., M.H.S.); Sutter Pacific Heart Centers, San Francisco, CA (R.E.S.); Carolina Pacific Medical Center, San Francisco, CA (M.T.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (E.S.B.); and Denver Veterans Affairs Medical Center, CO (J.C.M.)
| | - John C. Messenger
- From the Duke Clinical Research Institute, Durham, NC (J.M.B., W.A.-H., D.D., S.V.R., K.J.A., E.D.P., P.S.D., M.H.S.); Sutter Pacific Heart Centers, San Francisco, CA (R.E.S.); Carolina Pacific Medical Center, San Francisco, CA (M.T.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (E.S.B.); and Denver Veterans Affairs Medical Center, CO (J.C.M.)
| | - Eric D. Peterson
- From the Duke Clinical Research Institute, Durham, NC (J.M.B., W.A.-H., D.D., S.V.R., K.J.A., E.D.P., P.S.D., M.H.S.); Sutter Pacific Heart Centers, San Francisco, CA (R.E.S.); Carolina Pacific Medical Center, San Francisco, CA (M.T.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (E.S.B.); and Denver Veterans Affairs Medical Center, CO (J.C.M.)
| | - Pamela S. Douglas
- From the Duke Clinical Research Institute, Durham, NC (J.M.B., W.A.-H., D.D., S.V.R., K.J.A., E.D.P., P.S.D., M.H.S.); Sutter Pacific Heart Centers, San Francisco, CA (R.E.S.); Carolina Pacific Medical Center, San Francisco, CA (M.T.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (E.S.B.); and Denver Veterans Affairs Medical Center, CO (J.C.M.)
| | - Michael H. Sketch
- From the Duke Clinical Research Institute, Durham, NC (J.M.B., W.A.-H., D.D., S.V.R., K.J.A., E.D.P., P.S.D., M.H.S.); Sutter Pacific Heart Centers, San Francisco, CA (R.E.S.); Carolina Pacific Medical Center, San Francisco, CA (M.T.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (E.S.B.); and Denver Veterans Affairs Medical Center, CO (J.C.M.)
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Sadr-Ameli M, Mousavi H, Heidarali M, Maadani M, Ghelich Y, Ghadrdoost B. Early and midterm major adverse cardiac events in patient with saphenous vein graft using direct stenting or embolic protection device stenting. Res Cardiovasc Med 2014; 3:e13012. [PMID: 25478526 PMCID: PMC4253743 DOI: 10.5812/cardiovascmed.13012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 08/24/2013] [Accepted: 11/15/2013] [Indexed: 11/16/2022] Open
Abstract
Background: The treatment of an occluded saphenous vein graft (SVG) with percutaneous coronary intervention may encounter major adverse cardiac events (MACE). MACE rates have been reduced significantly by using the embolic protection device (EPD). Objectives: The aim of this study was to clarify the risks and the benefits of embolic protection devices. Patients and Methods: In a prospective, non-randomized observational study, patients aged 33 to 85 years old who underwent elective percutaneous coronary intervention due to SVG stenosis at our tertiary care center were enrolled between 2009 and 2011. The incidence rates of adverse events, including MACE, were obtained during the patients’ hospitalization and at 30-day and 6-month follow-up. MACE included death, Q-wave and non-Q-wave myocardial infarction, in-stent thrombosis, target lesion revascularization, and target vessel revascularization. Results: From 150 patients enrolled to the study, 128 (85.3%) patients underwent direct stenting and the rest underwent the EPD procedure. In-hospital MACE occurred in 17.2% of the patients in the direct stenting group versus only 9.1% in the EPD group (P = 0.530). MACE incidence was gradually increased at one and 6-month follow-up periods in the direct stenting group (19.5% and 21.9%, respectively), and remained unchanged in the EPD group (9.1% at six-month follow-up). Multivariate logistic regression model showed that the stenting procedure type could not predict early and midterm MACE with the presence of baseline characteristics as cofounders. Conclusions: Despite the considerable lower early and midterm MACE rates, numerically following the EPD procedure compared to direct stenting, the difference in the MACE rates between the two groups was not significant.
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Affiliation(s)
- Mohammadali Sadr-Ameli
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Hossein Mousavi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Mona Heidarali
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Mohsen Maadani
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Mohsen Madaani, Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Vali-e-Asr St., Niayesh Blvd, Tehran, IR Iran. Tel: +98-2123923017, Fax: +98-2122663217, E-mail:
| | - Yones Ghelich
- Department of Intervention, 502 Military Hospital, Tehran, IR Iran
| | - Behshid Ghadrdoost
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
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