Stent-Only Versus Adjunctive Balloon Angioplasty Approach for Saphenous Vein Graft Percutaneous Coronary Intervention: Insights from DIVA Trial

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 MavromatisMei Chiung Shih, Subhash Banerjee, Emmanouil S. Brilakis

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Background: Direct stenting without pre-dilation or post-dilation has been advocated for saphenous vein graft percutaneous coronary intervention to decrease the incidence of distal embolization, periprocedural myocardial infarction, and target lesion revascularization. Methods: We performed a post hoc analysis of patients enrolled in the DIVA (Drug-Eluting Stents Versus Bare Metal Stents in Saphenous Vein Graft Angioplasty; NCT 01121224) prospective, double-blind, randomized controlled trial. Patients were stratified into stent-only and balloon-stent groups. Primary end point was 12-month incidence of target vessel failure (defined as the composite of cardiac death, target vessel myocardial infarction, or target vessel revascularization). Secondary end points included all-cause death, stent thrombosis, myocardial infarction, and target lesion revascularization during follow-up. Results: Of the 575 patients included in this substudy, 185 (32%) patients underwent stent-only percutaneous coronary intervention. Patients in the stent-only versus balloon-stent group had similar baseline characteristics and similar incidence of target vessel failure at 12-months (15% versus 19%; hazard ratio, 1.34 [95% CI, 0.86-2.08]; P=0.19). During long-term follow-up (median of 2.7 years), the incidence of definite stent thrombosis (1% versus 5%; hazard ratio, 9.20 [95% CI, 1.23-68.92]; P=0.0085), the composite of definite or probable stent thrombosis (5% versus 11%; hazard ratio, 2.52 [95% CI, 1.23-5.18]; P=0.009), and target vessel myocardial infarction (8% versus 14%; hazard ratio, 1.92 [95% CI, 1.08-3.40]; P=0.023) was lower in the stent-only group. Multivariable analysis showed that a higher number of years since coronary artery bypass grafting and >1 target saphenous vein graft lesions were associated with increased target vessel failure during entire follow-up, while preintervention Thrombolysis in Myocardial Infarction-3 flow was protective. Conclusions: In patients undergoing percutaneous coronary intervention of de novo saphenous vein graft lesions, there was no difference in target vessel failure at 12 months and long-term follow-up in the stent-only versus the balloon-stent group; however, the incidence of stent thrombosis was lower in the stent-only group, as was target vessel myocardial infarction. Registration: URL: Https://www.clinicaltrials.gov. Unique identifier: NCT 01121224.

Original languageEnglish (US)
Article numbere008494
JournalCirculation: Cardiovascular Interventions
DOIs
StateAccepted/In press - 2020

Keywords

  • angioplasty
  • dilatation
  • incidence
  • myocardial infarction
  • stents

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Latif, F., Uyeda, L., Edson, R., Bhatt, D. L., Goldman, S., Holmes, D. R., Rao, S. V., Shunk, K., Aggarwal, K., Uretsky, B., Bolad, I., Ziada, K., McFalls, E., Irimpen, A., Truong, H. T., Kinlay, S., Papademetriou, V., Velagaleti, R. S., Rangan, B. V., ... Brilakis, E. S. (Accepted/In press). Stent-Only Versus Adjunctive Balloon Angioplasty Approach for Saphenous Vein Graft Percutaneous Coronary Intervention: Insights from DIVA Trial. Circulation: Cardiovascular Interventions, [e008494]. https://doi.org/10.1161/CIRCINTERVENTIONS.119.008494