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Correlates of Adverse Events During Saphenous Vein Graft Intervention With Distal Embolic Protection

A PRIDE Substudy

Ajay J. Kirtane, MD, SM, FACC^_*, Eugene R. Heyman, PhD, Christopher Metzger, MD, FACC, Jeffrey A. Breall, MD, PhD, FACC, Joseph P. Carrozza, Jr, MD, FACC^||,_*

^_* Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, New York
Montgomery Village, Maryland
The Heart Center, Kingsport, Tennessee
Krannert Institute of Cardiology, Indiana University of Medicine, Indianapolis, Indiana
^|| Section of Interventional Cardiology, Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.

^_* Reprint requests and correspondence: Dr. Joseph P. Carrozza Jr., Chief, Section of Interventional Cardiology, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Baker 4, Boston, Massachusetts 02215. (Email: jcarrozz{at}bidmc.harvard.edu).

Objectives: We sought to identify correlates of 30-day adverse events among patients undergoing percutaneous coronary intervention (PCI) of saphenous vein grafts (SVG).

Background: Although the use of distal embolic protection devices during SVG intervention reduces major adverse cardiac events (MACE), many patients still experience MACE despite distal embolic protection, and the major predictors of MACE among these patients are not well-characterized.

Methods: Correlates of 30-day MACE and peri-procedural creatine kinase-myocardial band (CK-MB) elevation were assessed among 631 patients undergoing SVG intervention with distal embolic protection enrolled in the PRIDE (PRotection during saphenous vein graft Intervention to prevent Distal Embolization) study, a randomized comparison of the TriActiv System (Kensey-Nash Corp., Exton, Pennsylvania) with an active control group (Guardwire [Medtronic, Santa Clara, California] or Filterwire [Boston Scientific, Minneapolis, Minnesota]).

Results: Baseline covariates associated with MACE were longer lesion length, greater angiographically assessed estimated plaque volume, and higher SVG degeneration score. Graft age and angina class were not associated with adverse events. Angiographic lesion length was significantly correlated with more complex angiographic metrics such as estimated plaque volume and the SVG degeneration score. In multivariable analyses, angiographic lesion length was the strongest independent correlate of MACE (odds ratio [OR] 2.81 [95% confidence interval (CI) 1.82 to 4.34]/log-increase in lesion length, p < 0.001) with a graded increase in MACE observed with increasing lesion lengths. Similarly, the strongest independent correlate of CK-MB elevation was lesion length (OR 2.54 [95% CI 1.59 to 4.04]/log-increase in lesion length, p < 0.001). The associations between lesion length and both MACE and CK-MB elevation were consistent among the studied embolic protection devices (TriActiv, Guardwire, or Filterwire).

Conclusions: Angiographic lesion length was the strongest correlate of short-term adverse events among patients undergoing SVG intervention with distal embolic protection, with incremental effects noted at even relatively short lesion lengths.

Abbreviations and Acronyms   CI = confidence interval   CK-MB = creatine kinase-myocardial band   MACE = major adverse cardiac events   OR = odds ratio   PCI = percutaneous coronary intervention   SVG = saphenous vein graft