M Bilal Iqbal1,2, Imad J Nadra1,2, Lillian Ding3, Anthony Fung4, Eve Aymong5, Albert W Chan6, Steven Hodge7, Anthony Della Siega1,2, Simon D Robinson1,2. 1. Victoria Heart Institute Foundation, Victoria, British Columbia, Canada. 2. Royal Jubilee Hospital, Victoria, British Columbia, Canada. 3. Provincial Health Services Authority, Vancouver, British Columbia, Canada. 4. Vancouver General Hospital, Vancouver, British Columbia, Canada. 5. St. Paul's Hospital, Vancouver, British Columbia, Canada. 6. Royal Columbian Hospital, Vancouver, British Columbia, Canada. 7. Kelowna General Hospital, Kelowna, British Columbia, Canada.
Abstract
BACKGROUND: Embolic protection devices (EPDs) have been designed and introduced to reduce distal embolization and peri-procedural myocardial infarction during saphenous vein graft (SVG) intervention. Current guidelines give a class I recommendation to EPD use during SVG intervention when technically feasible. However, the routine use of these devices has recently been debated. METHODS: We analyzed 1,359 patients undergoing isolated SVG intervention between 2008 and 2013 in the British Columbia Cardiac Registry. We analyzed (a) post-procedural TIMI flow; and (b) target vessel revascularization (TVR) and mortality at 1 and 2 years. RESULTS: EPD use was an independent predictor of post-procedural TIMI 2/3 flow (OR = 2.38, 95% CI: 1.51-3.74, P < 0.001). At 1 year, EPD use was an independent predictor for lower TVR (HR = 0.35, 95% CI: 0.14-0.85, P = 0.021) and a trend towards lower mortality (HR = 0.45, 95% CI: 0.18-1.10, P = 0.082). These associations were lost at 2 years where EPD use was not predictive of mortality (HR = 0.62, 95% CI: 0.33-1.17, P = 0.144) or TVR (HR = 0.70, 95% CI: 0.41-1.17, P = 0.176). These findings were confirmed in propensity-matched and inverse probability treatment weighted analyses. CONCLUSIONS: In this analysis of patients undergoing SVG intervention, EPD use was a strong predictor for improved post-procedural TIMI flow. Whilst EPD use was associated with lower TVR and a trend for lower mortality at 1 year, these associations were lost at 2 years. These findings would appear to support the use of EPD for SVG intervention.
BACKGROUND:Embolic protection devices (EPDs) have been designed and introduced to reduce distal embolization and peri-procedural myocardial infarction during saphenous vein graft (SVG) intervention. Current guidelines give a class I recommendation to EPD use during SVG intervention when technically feasible. However, the routine use of these devices has recently been debated. METHODS: We analyzed 1,359 patients undergoing isolated SVG intervention between 2008 and 2013 in the British Columbia Cardiac Registry. We analyzed (a) post-procedural TIMI flow; and (b) target vessel revascularization (TVR) and mortality at 1 and 2 years. RESULTS: EPD use was an independent predictor of post-procedural TIMI 2/3 flow (OR = 2.38, 95% CI: 1.51-3.74, P < 0.001). At 1 year, EPD use was an independent predictor for lower TVR (HR = 0.35, 95% CI: 0.14-0.85, P = 0.021) and a trend towards lower mortality (HR = 0.45, 95% CI: 0.18-1.10, P = 0.082). These associations were lost at 2 years where EPD use was not predictive of mortality (HR = 0.62, 95% CI: 0.33-1.17, P = 0.144) or TVR (HR = 0.70, 95% CI: 0.41-1.17, P = 0.176). These findings were confirmed in propensity-matched and inverse probability treatment weighted analyses. CONCLUSIONS: In this analysis of patients undergoing SVG intervention, EPD use was a strong predictor for improved post-procedural TIMI flow. Whilst EPD use was associated with lower TVR and a trend for lower mortality at 1 year, these associations were lost at 2 years. These findings would appear to support the use of EPD for SVG intervention.
Authors: Wojciech Wańha; Maksymilian Mielczarek; Natasza Gilis-Malinowska; Tomasz Roleder; Marek Milewski; Szymon Ładziński; Dariusz Ciećwierz; Paweł Gąsior; Tomasz Pawłowski; Rafał Januszek; Adam Kowalówka; Michalina Kolodziejczak; Stanisław Bartuś; Marcin Gruchała; Grzegorz Smolka; Eliano Pio Navarese; Dariusz Dudek; Andrzej Ochała; Elvin Kedhi; Miłosz Jaguszewski; Wojciech Wojakowski Journal: J Clin Med Date: 2020-04-22 Impact factor: 4.241