Abstract 12623: Contemporary Embolic Protection in Saphenous Vein Graft Intervention. 3-Year Outcomes From 49,325 Patients in the Medicare-Linked NCDR CathPCI Registry
Background: Data supporting the continued use of embolic protection devices (EPD) in contemporary saphenous vein graft (SVG) intervention is limited, and survey data indicate low uptake of EPD in clinical practice.
Methods: Using the CathPCI Registry-Medicare linked cohort (2005-2009) (n=49,325 SVG interventions), propensity score methods were used to examine the association between EPD use and both procedural and long-term major adverse cardiac events (death, myocardial infarction, or any repeat revascularization) among patients ≥ 65 years old. Prespecified subgroups included those with and without ACS, with denovo or instent lesions, and by graft lesion location (aortic or distal anastomosis or graft body).
Results: An EPD was used in 21.2% of SVG interventions (median age, 75; 23% female)_more commonly among ACS cases (22 vs. 19%), in denovo (vs. restenotic) lesions (22% vs. 14%), and among graft body (vs. aortic anastomosis and distal anastomosis) lesions (24% vs. 20% vs. 8%, respectively). Procedural complications were slightly more common in EPD cases, including no reflow (3.9% vs. 2.8%, p≤0.001), vessel dissection (1.3% vs. 1.1%, p=0.05), perforation (0.7% vs. 0.4%, p=0.001), and peri-procedural MI (2.8% vs. 1.8%, p≤0.001). To 3 years follow-up, no reduction in the incidence of MACE was observed among EPD cases (vs. no EPD, p=0.14). Following risk-adjustment, EPD use was not associated with a lower risk of MACE (or any of its components) in the overall cohort (adjusted HR 1.01, 0.98 to 1.05) or among any of the pre-specified clinical subgroups (p-interaction = ns for each subgroup).
Conclusions: In this contemporary cohort, EPD use was more common among patients with higher risk clinical indications. However, despite risk adjustment, procedural complications were more frequent in the EPD cohort, and no improvement in early, mid or long-term outcomes was observed with EPD use_independent of clinical setting, prior lesion treatment, or lesion location.
- © 2013 by American Heart Association, Inc.