Abstract 3440: Frequency and Predictors of Post-Procedural Myonecrosis in Saphenous Vein Graft Intervention in the Stent Era: A Meta-Regression
Background: Evaluations of the frequency and predictors of peri-procedural myonecrosis in saphenous vein graft (SVG) percutaneous coronary intervention (PCI) have been hampered by limited sample sizes.
Methods: Medline search and reference review for SVG PCI identified 172 publications of randomized trials, registries, or consecutive series. Data was abstracted from the 14 studies where stenting was planned, creatinine kinase-myocardial band (CK-MB) were systematically collected and reported, acute myocardial infarction patients were excluded, and sample size was ≥ 50.
Results: The 14 studies enrolled 5,310 patients with mean age of 68.4±6.1 years, 80.4% males, and 33.2% diabetics. The mean graft age was 9.0±0.7 years, 1.3±0.1 lesions were treated in the graft, and 23.6% had angiographic filling defects. Distal protection devices were used in 25.1% and IIb/IIIa antagonist in 24.7%. Post-procedural CK-MB elevation ≥3 times the upper limit of normal (uln) was observed in 18.5±2.1% of the patients. A subset with total sample size of 3,430 reported CK-MB ≥5 times the uln in 16.1±3.3%. Among patients (n=1,335) receiving distal protection (DPD), the rate of CK-MB ≥ 3 times uln was 9.4±0.7% compared to 22.2±3.8% without (n=3,825). In univariate meta-regression analysis, DPD use (p<0.0001), IIb/IIIa anatagonist use (p=0.002), and higher LVEF (p<0.0001) were significantly associated with a lower risk of post-procedural myonecrosis. Graft age, angiographic filling defects, diabetes, lesion length, and number of lesions treated per graft were not significant predictors of post-procedural myonecrosis. In multivariate meta-regression, higher LVEF and DPDs remained significantly associated with lower post-procedural myonecrosis but IIb/IIIa receptor antagonist was not.
Conclusions: Post-procedural myonecrosis remains common in SVG PCI in the stent era. Low pre-procedural ejection fraction was the most powerful predictor of post-procedural myonecrosis (R2=0.91). The use of DPDs, perhaps IIb/IIIa therapy, and other micro-and macrovascular distal protection strategies should be strongly considered particularly in patients with low LVEF undergoing SVG PCI.