Published Online
on January 22, 2008

A more recent version of this article appeared on February 12, 2008

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Submitted on July 21, 2006
Accepted on November 27, 2007

Saphenous Vein Graft Stenting and Major Adverse Cardiac Events. A Predictive Model Derived From a Pooled Analysis of 3958 Patients

Alanna Coolong MD, MSc, Donald S. Baim MD, Richard E. Kuntz MD, MSc, A. James O’Malley PhD, Sachin Marulkar MBBS, MPH, Donald E. Cutlip MD, Jeffrey J. Popma MD, and Laura Mauri MD, MSc^*

From the Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass (A.C., L.M.); Boston Scientific, Natick, Mass (D.S.B.); Medtronic, Minneapolis, Minn (R.E.K.); and Department of Health Care Policy, Harvard Medical School (A.J.O.), Beth Israel-Deaconess Medical Center (D.E.C.), St Elizabeth’s Medical Center (J.J.P.), and Harvard Clinical Research Institute (A.C., S.M., D.E.C., L.M.), Boston, Mass.

^* To whom correspondence should be addressed. E-mail: lmauri1{at}partners.org.

Background—Treatment of saphenous vein graft (SVG) stenosis with percutaneous coronary intervention has a 15% to 20% incidence of major adverse cardiac events (MACE) within 30 days. Although MACE rates are reduced significantly by the use of embolic protection devices (EPDs), neither the level of baseline risk nor the benefit provided by EPDs has been well characterized.

Methods and Results—Data from 5 randomized controlled trials and 1 registry evaluating EPDs in SVG percutaneous coronary intervention (n=3958 patients) were pooled for analysis. MACE was defined as a composite of death, myocardial infarction, and target vessel revascularization. Baseline variables and 2 summary angiographic variables (an SVG degeneration score and an estimate of lesion plaque volume) were included in a multivariable logistic regression model to predict 30-day MACE, with adjustment for the type of device used and inter-study variation. The angiographic variables were potent predictors of MACE (increasing SVG degeneration score, P<0.0001; larger estimated plaque volume, P<0.0001), with significant contributions from the presence of thrombus (P<0.01), increasing patient age (P<0.01), glycoprotein IIb/IIIa inhibitor use (P=0.02), and current tobacco abuse (P=0.03). The treatment benefit of EPDs was preserved across all categories of risk as categorized by SVG degeneration or plaque volume.

Conclusions—The strongest predictors of 30-day MACE in SVG percutaneous coronary intervention are angiographic estimates of plaque volume and SVG degeneration. Identification of these predictors of 30-day MACE allows reliable prediction of patient outcomes and confirms consistent treatment benefit with the use of EPDs across the range of patients tested in randomized trials.

Key words: bypass • grafting • stents

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Clinical Summaries
Circulation 2008 117: 711-713. [Full Text]

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