Shoaib, A, Kinnaird, T, Curzen, N, Ludman, P, Smith, D, Khoo, CW, Kontopantelis, E, Rashid, M, Mohamed, M, Nolan, J, Zaman, A and Mamas, MA (2019) Outcomes Following Percutaneous Coronary Intervention in Saphenous Vein Grafts With and Without Embolic Protection Devices. JACC: Cardiovascular Interventions, 12 (22). 2286 -2295.

[img] Text
EPD-Manuscript-.docx - Accepted Version
Restricted to Repository staff only until 18 November 2020.
Available under License Creative Commons Attribution Non-commercial No Derivatives.

Download (101kB)
[img] Image
Centeral illustration figure.tif - Supplemental Material
Restricted to Repository staff only until 18 November 2020.
Available under License Creative Commons Attribution Non-commercial No Derivatives.

Download (14MB)
[img] Image
Figure 1.tiff - Supplemental Material
Restricted to Repository staff only until 18 November 2020.
Available under License Creative Commons Attribution Non-commercial No Derivatives.

Download (44MB)
[img] Text
Figure 2.gph - Supplemental Material
Restricted to Repository staff only until 18 November 2020.
Available under License Creative Commons Attribution Non-commercial No Derivatives.

Download (22kB)
[img] Text
Table 1.docx - Supplemental Material
Restricted to Repository staff only until 18 November 2020.
Available under License Creative Commons Attribution Non-commercial No Derivatives.

Download (19kB)
[img] Text
Table 2.docx - Supplemental Material
Restricted to Repository staff only until 18 November 2020.
Available under License Creative Commons Attribution Non-commercial No Derivatives.

Download (13kB)
[img] Text
Table 3.docx - Supplemental Material
Restricted to Repository staff only until 18 November 2020.
Available under License Creative Commons Attribution Non-commercial No Derivatives.

Download (15kB)
[img] Text
Table 4.docx - Supplemental Material
Restricted to Repository staff only until 18 November 2020.
Available under License Creative Commons Attribution Non-commercial No Derivatives.

Download (15kB)
[img] Text
Table 5.docx - Supplemental Material
Restricted to Repository staff only until 18 November 2020.
Available under License Creative Commons Attribution Non-commercial No Derivatives.

Download (14kB)
[img] Text
Supplement Material.docx - Supplemental Material
Restricted to Repository staff only until 18 November 2020.
Available under License Creative Commons Attribution Non-commercial No Derivatives.

Download (688kB)

Abstract

OBJECTIVES: The aim of this study was to describe the early (inpatient and 30-day) and late (1-year) outcomes of percutaneous coronary intervention (PCI) in saphenous vein grafts (SVGs), with and without the use of embolic protection devices (EPD), in a large, contemporary, unselected national cohort from the database of the British Cardiovascular Intervention Society.

BACKGROUND: There are limited, and discrepant, data on the clinical benefits of the adjunctive use of EPDs during PCI to SVGs in the contemporary era.

METHODS: A longitudinal cohort of patients (2007 to 2014, n = 20,642) who underwent PCI to SVGs in the British Cardiovascular Intervention Society database was formed. Clinical, demographic, procedural, and outcome data were analyzed by dividing into 2 groups: no EPD (PCI to SVGs without EPDs, n = 17,730) and EPD (PCI to SVGs with EPDs, n = 2,912).

RESULTS: Patients in the EPD group were older, had more comorbidities, and had a higher prevalence of moderate to severe left ventricular systolic dysfunction. Mortality was lower in the EPD group during hospital admission (0.70% vs. 1.29%; p = 0.008) and at 30 days (1.44% vs. 2.01%; p = 0.04) but similar at 1 year (6.22% vs. 6.01%; p = 0.67). Following multivariate analyses, no significant difference in mortality was observed during index admission (odds ratio [OR]: 0.71; 95% confidence interval [CI]: 0.42 to 1.19; p = 0.19), at 30 days (OR: 0.87; 95% CI: 0.60 to 1.25; p = 0.45), and at 1 year (OR: 0.92; 95% CI: 0.77 to 1.11; p = 0.41), along with similar rates of in-hospital major adverse cardiovascular events (OR: 1.16; 95% CI: 0.83 to 1.62; p = 0.39) and stroke (OR: 0.68; 95% CI: 0.20 to 2.35; p = 0.54). In propensity score-matched analyses, lower inpatient mortality was observed in the EPD group (OR: 0.46; 95% CI: 0.13 to 0.80; p = 0.002), although the adjusted risk for the periprocedural no-reflow or slow-flow phenomenon was higher in patients in whom EPDs were used (OR: 2.16; 95% CI: 1.71 to 2.73; p < 0.001).

CONCLUSIONS: In this contemporary cohort, EPDs were used more commonly in higher risk patients but were associated with similar clinical outcomes in multivariate analyses. Lower inpatient mortality was observed in the EPD group in univariate and propensity score-matched analyses.

Item Type: Article
Additional Information: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via Elsevier at http://doi.org/10.1016/j.jcin.2019.08.037 - please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: embolic protection devices, mortality, no flow, percutaneous coronary intervention, saphenous vein grafts
Subjects: R Medicine > RC Internal medicine > RC666 Diseases of the circulatory (Cardiovascular) system
R Medicine > RD Surgery > RD32 Operative surgery. Technique of surgical operations
Divisions: Faculty of Medicine and Health Sciences > Primary Care Health Sciences
Related URLs:
Depositing User: Symplectic
Date Deposited: 05 Dec 2019 09:09
Last Modified: 09 Dec 2019 15:44
URI: http://eprints.keele.ac.uk/id/eprint/7331

Actions (login required)

View Item View Item