Author + information
- Received April 8, 2019
- Revision received August 20, 2019
- Accepted August 27, 2019
- Published online November 18, 2019.
- Ahmad Shoaib, MDa,
- Tim Kinnaird, MDb,
- Nick Curzen, PhDc,
- Peter Ludman, MDd,
- David Smith, MDe,
- Chee W. Khoo, MDf,
- Evangelos Kontopantelis, PhDg,
- Muhammad Rashid, MBBSa,
- Mohamed Mohamed, MBBSa,
- James Nolan, MDa,
- Azfar Zaman, MDh,
- Mamas A. Mamas, DPhila,∗ (, )
- on behalf of the British Cardiovascular Intervention Society,
- National Institute for Cardiovascular Outcomes Research
- aKeele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom
- bUniversity Hospital of Wales, Cardiff, United Kingdom
- cUniversity of Southampton, Southampton, United Kingdom
- dQueen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
- eRegional Cardiac Centre, Morrison Hospital Swansea, Wales, United Kingdom
- fRoyal Stoke University Hospital, Stoke-on-Trent, United Kingdom
- gInstitute for Primary Care Sciences, University of Manchester, United Kingdom
- hNewcastle University, Newcastle upon Tyne, United Kingdom
- ↵∗Address for correspondence:
Prof. Mamas A. Mamas, Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent ST5 5BG, United Kingdom.
Objectives The aim of this study was to describe the early (inpatient and 30-day) and late (1-year) outcomes of percutaneous coronary intervention (PCI) in saphenous vein grafts (SVGs), with and without the use of embolic protection devices (EPD), in a large, contemporary, unselected national cohort from the database of the British Cardiovascular Intervention Society.
Background There are limited, and discrepant, data on the clinical benefits of the adjunctive use of EPDs during PCI to SVGs in the contemporary era.
Methods A longitudinal cohort of patients (2007 to 2014, n = 20,642) who underwent PCI to SVGs in the British Cardiovascular Intervention Society database was formed. Clinical, demographic, procedural, and outcome data were analyzed by dividing into 2 groups: no EPD (PCI to SVGs without EPDs, n = 17,730) and EPD (PCI to SVGs with EPDs, n = 2,912).
Results Patients in the EPD group were older, had more comorbidities, and had a higher prevalence of moderate to severe left ventricular systolic dysfunction. Mortality was lower in the EPD group during hospital admission (0.70% vs. 1.29%; p = 0.008) and at 30 days (1.44% vs. 2.01%; p = 0.04) but similar at 1 year (6.22% vs. 6.01%; p = 0.67). Following multivariate analyses, no significant difference in mortality was observed during index admission (odds ratio [OR]: 0.71; 95% confidence interval [CI]: 0.42 to 1.19; p = 0.19), at 30 days (OR: 0.87; 95% CI: 0.60 to 1.25; p = 0.45), and at 1 year (OR: 0.92; 95% CI: 0.77 to 1.11; p = 0.41), along with similar rates of in-hospital major adverse cardiovascular events (OR: 1.16; 95% CI: 0.83 to 1.62; p = 0.39) and stroke (OR: 0.68; 95% CI: 0.20 to 2.35; p = 0.54). In propensity score–matched analyses, lower inpatient mortality was observed in the EPD group (OR: 0.46; 95% CI: 0.13 to 0.80; p = 0.002), although the adjusted risk for the periprocedural no-reflow or slow-flow phenomenon was higher in patients in whom EPDs were used (OR: 2.16; 95% CI: 1.71 to 2.73; p < 0.001).
Conclusions In this contemporary cohort, EPDs were used more commonly in higher risk patients but were associated with similar clinical outcomes in multivariate analyses. Lower inpatient mortality was observed in the EPD group in univariate and propensity score–matched analyses.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 8, 2019.
- Revision received August 20, 2019.
- Accepted August 27, 2019.
- 2019 American College of Cardiology Foundation
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