Björn Redfors1, Philippe Généreux2, Bernhard Witzenbichler1, Thomas McAndrew1, Jamie Diamond1, Xin Huang1, Akiko Maehara1, Giora Weisz1, Roxana Mehran1, Ajay J Kirtane1, Gregg W Stone1. 1. From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (B.R., P.G., T.M., X.H., A.M., G.W., R.M., A.J.K., G.W.S.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center (J.D., A.M., G.W., A.J.K., G.W.S.); Gagnon Cardiovascular Institute, Morristown Medical Center, NJ (P.G.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Quebec, Canada (P.G.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.). 2. From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (B.R., P.G., T.M., X.H., A.M., G.W., R.M., A.J.K., G.W.S.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center (J.D., A.M., G.W., A.J.K., G.W.S.); Gagnon Cardiovascular Institute, Morristown Medical Center, NJ (P.G.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Quebec, Canada (P.G.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.). pgenereux@crf.org.
Abstract
BACKGROUND: Percutaneous coronary intervention (PCI) of saphenous vein grafts (SVGs) has historically been associated with a high risk of adverse ischemic events, but there is a paucity of contemporary data on the second-generation drug-eluting stent use within SVG, and the relative importance of high platelet reactivity (HPR) in SVG PCI versus native lesion PCI is unknown. We studied ischemic and bleeding events after SVG PCI and their association with HPR. METHODS AND RESULTS: Subjects in the prospective, multicenter ADAPT-DES study (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) were stratified according to whether they had PCI of an SVG or a non-SVG lesion. Two-year outcomes were compared between groups using univariate and multivariable Cox proportional hazards models. HPR was defined as on-clopidogrel P2Y12 platelet reaction units >208 as measured by the VerifyNow assay; major adverse cardiac events were defined as the composite of cardiac death, myocardial infarction, or stent thrombosis. Among 8582 subjects in ADAPT-DES, 405 (4.7%) had SVG PCI. SVG PCI was independently associated with a higher 2-year risk of major adverse cardiac events (adjusted hazard ratio, 2.34; 95% confidence interval, 1.69-3.23; P<0.0001), ischemia-driven target vessel revascularization (adjusted hazard ratio, 1.82; 95% confidence interval, 1.37-2.42; P<0.0001), and stent thrombosis (adjusted hazard ratio, 2.26; 95% confidence interval, 1.42-3.59; P=0.0006), but not of bleeding (adjusted hazard ratio, 0.99; 95% confidence interval, 0.68-1.46; P=0.97). There was no statistical interaction between HPR and SVG PCI in regard to major adverse cardiac events (adjusted Pinteraction=0.99). CONCLUSIONS: SVG PCI is associated with a considerably higher risk of 2-year adverse ischemic events, with HPR conferring similar risk in SVG and non-SVG PCI. More potent and longer antiplatelet therapy may be beneficial for patients undergoing SVG PCI. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00638794.
BACKGROUND: Percutaneous coronary intervention (PCI) of saphenous vein grafts (SVGs) has historically been associated with a high risk of adverse ischemic events, but there is a paucity of contemporary data on the second-generation drug-eluting stent use within SVG, and the relative importance of high platelet reactivity (HPR) in SVG PCI versus native lesion PCI is unknown. We studied ischemic and bleeding events after SVG PCI and their association with HPR. METHODS AND RESULTS: Subjects in the prospective, multicenter ADAPT-DES study (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) were stratified according to whether they had PCI of an SVG or a non-SVG lesion. Two-year outcomes were compared between groups using univariate and multivariable Cox proportional hazards models. HPR was defined as on-clopidogrelP2Y12 platelet reaction units >208 as measured by the VerifyNow assay; major adverse cardiac events were defined as the composite of cardiac death, myocardial infarction, or stent thrombosis. Among 8582 subjects in ADAPT-DES, 405 (4.7%) had SVG PCI. SVG PCI was independently associated with a higher 2-year risk of major adverse cardiac events (adjusted hazard ratio, 2.34; 95% confidence interval, 1.69-3.23; P<0.0001), ischemia-driven target vessel revascularization (adjusted hazard ratio, 1.82; 95% confidence interval, 1.37-2.42; P<0.0001), and stent thrombosis (adjusted hazard ratio, 2.26; 95% confidence interval, 1.42-3.59; P=0.0006), but not of bleeding (adjusted hazard ratio, 0.99; 95% confidence interval, 0.68-1.46; P=0.97). There was no statistical interaction between HPR and SVG PCI in regard to major adverse cardiac events (adjusted Pinteraction=0.99). CONCLUSIONS: SVG PCI is associated with a considerably higher risk of 2-year adverse ischemic events, with HPR conferring similar risk in SVG and non-SVG PCI. More potent and longer antiplatelet therapy may be beneficial for patients undergoing SVG PCI. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00638794.
Authors: Faisal Latif; Lauren Uyeda; Robert Edson; Deepak L Bhatt; Steven Goldman; David R Holmes; Sunil V Rao; Kendrick Shunk; Kul Aggarwal; Barry Uretsky; Islam Bolad; Khaled Ziada; Edward McFalls; Anand Irimpen; Huu Tam Truong; Scott Kinlay; Vasilios Papademetriou; Raghava S Velagaleti; Bavana V Rangan; Kreton Mavromatis; Mei-Chiung Shih; Subhash Banerjee; Emmanouil S Brilakis Journal: Circ Cardiovasc Interv Date: 2020-02-05 Impact factor: 6.546
Authors: Mark Kheifets; Shelly Abigail Vons; Tamir Bental; Hana Vaknin-Assa; Gabriel Greenberg; Abed Samara; Pablo Codner; Guy Wittberg; Yeela Talmor Barkan; Leor Perl; Ran Kornowski; Amos Levi Journal: Front Cardiovasc Med Date: 2022-06-24