Embolic protection device use and its association with procedural safety and long-term outcomes following saphenous vein graft intervention: An analysis from the British Columbia Cardiac registry

• Published in: Catheterization and cardiovascular interventions Vol. 88; no. 1; pp. 73 - 83
• Main Authors: Iqbal, M. Bilal, Nadra, Imad J., Ding, Lillian, Fung, Anthony, Aymong, Eve, Chan, Albert W., Hodge, Steven, Della Siega, Anthony, Robinson, Simon D.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.07.2016; Wiley Subscription Services, Inc
• Subjects: Aged; Aged, 80 and over; British Columbia; Coronary Artery Bypass - adverse effects; Coronary Artery Bypass - mortality; Coronary Circulation; embolic protection device; Embolic Protection Devices; Embolism - etiology; Embolism - prevention & control; Female; Graft Occlusion, Vascular - etiology; Graft Occlusion, Vascular - mortality; Graft Occlusion, Vascular - physiopathology; Graft Occlusion, Vascular - therapy; Humans; Kaplan-Meier Estimate; Logistic Models; Male; mortality; Multivariate Analysis; Myocardial Infarction - etiology; Myocardial Infarction - prevention & control; Odds Ratio; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - instrumentation; Percutaneous Coronary Intervention - mortality; post-procedural flow; Propensity Score; Proportional Hazards Models; Protective Factors; Regional Blood Flow; Registries; Retrospective Studies; Risk Factors; Saphenous Vein - physiopathology; Saphenous Vein - transplantation; saphenous vein graft; target vessel revascularization; Time Factors; Treatment Outcome; Vascular Patency; saphenous vein graft; embolic protection device; mortality; target vessel revascularization; post-procedural flow
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.26237

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. © 2015 Wiley Periodicals, Inc.