Utilization of Distal Embolic Protection in Saphenous Vein Graft Interventions (An Analysis of 19,546 Patients in the American College of Cardiology-National Cardiovascular Data Registry)

Sameer K. Mehta, Andrew D. Frutkin, Sarah Milford-Beland, Lloyd W. Klein, Richard E. Shaw, William S. Weintraub, Ronald J. Krone, H. Vernon Anderson, Michael A. Kutcher, Steven P. Marso

Research output: Contribution to journalArticle

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Abstract

In clinical trials, the use of a distal embolic protection device (EPD) during saphenous vein graft (SVG) percutaneous intervention (PCI) decreases the incidence of major adverse events. However, the frequency of EPD use during SVG PCI in clinical practice is unknown. We evaluated 19,546 SVG PCI procedures in the American College of Cardiology-National Cardiovascular Data Registry from January 1, 2004, through March 30, 2006. EPD use was the primary outcome. Univariate and multivariable analyses were used to assess for characteristics associated with EPD use and to determine the association between EPD use and 2 outcomes: no-reflow and in-hospital mortality. EPDs were used in 22% of patients who underwent SVG PCI. Characteristics independently associated with EPD use were age (odds ratio [OR] 1.04, p = 0.03), male gender (OR 1.12, p = 0.02), older grafts (p <0.001 for the group), longer lesions (OR 1.16, p <0.001), and American College of Cardiology/American Heart Association class C lesions (OR 1.41, p <0.001). Patients were less likely to receive an EPD if they had class <3 grade flow according to Thrombolysis in Myocardial Infarction classification (p <0.001) or previously treated lesions (OR 0.55, p <0.001). There was a weak correlation between annual hospital PCI volume and EPD use (r = 0.2, p <0.001). Nineteen percent of centers did not use EPDs and 41% used them in <10% of cases. EPD use was independently associated with a lower incidence of no-reflow (OR 0.68, p = 0.032), but not in-hospital mortality (1.0% vs 0.9%, p = NS). In conclusion, in current practice, EPDs are used in <25% of SVG PCI procedures.

Original languageEnglish (US)
Pages (from-to)1114-1118
Number of pages5
JournalAmerican Journal of Cardiology
Volume100
Issue number7
DOIs
StatePublished - Oct 1 2007

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Embolic Protection Devices
Saphenous Vein
Registries
Transplants
Odds Ratio
Hospital Mortality
Incidence
Myocardial Infarction
Clinical Trials

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Utilization of Distal Embolic Protection in Saphenous Vein Graft Interventions (An Analysis of 19,546 Patients in the American College of Cardiology-National Cardiovascular Data Registry). / Mehta, Sameer K.; Frutkin, Andrew D.; Milford-Beland, Sarah; Klein, Lloyd W.; Shaw, Richard E.; Weintraub, William S.; Krone, Ronald J.; Anderson, H. Vernon; Kutcher, Michael A.; Marso, Steven P.

In: American Journal of Cardiology, Vol. 100, No. 7, 01.10.2007, p. 1114-1118.

Research output: Contribution to journalArticle

Mehta, Sameer K. ; Frutkin, Andrew D. ; Milford-Beland, Sarah ; Klein, Lloyd W. ; Shaw, Richard E. ; Weintraub, William S. ; Krone, Ronald J. ; Anderson, H. Vernon ; Kutcher, Michael A. ; Marso, Steven P. / Utilization of Distal Embolic Protection in Saphenous Vein Graft Interventions (An Analysis of 19,546 Patients in the American College of Cardiology-National Cardiovascular Data Registry). In: American Journal of Cardiology. 2007 ; Vol. 100, No. 7. pp. 1114-1118.
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abstract = "In clinical trials, the use of a distal embolic protection device (EPD) during saphenous vein graft (SVG) percutaneous intervention (PCI) decreases the incidence of major adverse events. However, the frequency of EPD use during SVG PCI in clinical practice is unknown. We evaluated 19,546 SVG PCI procedures in the American College of Cardiology-National Cardiovascular Data Registry from January 1, 2004, through March 30, 2006. EPD use was the primary outcome. Univariate and multivariable analyses were used to assess for characteristics associated with EPD use and to determine the association between EPD use and 2 outcomes: no-reflow and in-hospital mortality. EPDs were used in 22{\%} of patients who underwent SVG PCI. Characteristics independently associated with EPD use were age (odds ratio [OR] 1.04, p = 0.03), male gender (OR 1.12, p = 0.02), older grafts (p <0.001 for the group), longer lesions (OR 1.16, p <0.001), and American College of Cardiology/American Heart Association class C lesions (OR 1.41, p <0.001). Patients were less likely to receive an EPD if they had class <3 grade flow according to Thrombolysis in Myocardial Infarction classification (p <0.001) or previously treated lesions (OR 0.55, p <0.001). There was a weak correlation between annual hospital PCI volume and EPD use (r = 0.2, p <0.001). Nineteen percent of centers did not use EPDs and 41{\%} used them in <10{\%} of cases. EPD use was independently associated with a lower incidence of no-reflow (OR 0.68, p = 0.032), but not in-hospital mortality (1.0{\%} vs 0.9{\%}, p = NS). In conclusion, in current practice, EPDs are used in <25{\%} of SVG PCI procedures.",
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