title: GuardWire emboli protection device is associated with improved myocardial perfusion grade in saphenous vein graft intervention.
abstract: BACKGROUND
  Use of emboli protection devices (EPD) during saphenous vein graft percutaneous coronary intervention (SVG-PCI) has been proven to reduce major adverse cardiac events (MACE). However, the impact of EPD on the microcirculation using Thrombolysis in Myocardial Infarction myocardial perfusion grade (TMP) has not been fully characterized. We sought to analyze TMP after SVG-PCI with and without EPD and determine its impact on inhospital MACE.
  
  
  METHODS
  From August 2001 to December 2002, 305 patients had SVG-PCI suitable for EPD; 210 (69%) had an angiogram appropriate for TMP evaluation. Of those, 46 (22%) had an EPD (GuardWire, Medtronic, Minneapolis, Minn) deployed during the coronary intervention. Both groups were similar with regard to most demographic and clinical features.
  
  
  RESULTS
  A TMP score of 2.5 or 3 was obtained in 98% of the EPD group versus 85% of the unprotected SVG-PCI (P = .01). There was a trend towards reduction in MACE when using EPD (15% vs 27%, respectively, P = .07). Peak postprocedural creatine kinase-MB was somewhat lower in the EPD group (6.03 +/- 7.8 ng/mL vs 14.87 +/- 42 ng/mL, P = .17) Patients with a TMP grade of 2.5 or 3 had a statistically significant reduction in MACE (OR 0.36, 95% CI 0.14-0.87, P = .02).
  
  
  CONCLUSIONS
  Compared with SVG-PCI without emboli protection, EPD significantly improved TMP and trended towards a reduction in MACE.
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Jose E
authors.initials: JE
authors.lastname: Exaire
authors.forename: Sorin J
authors.initials: SJ
authors.lastname: Brener
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Ellis
authors.forename: Jay S
authors.initials: JS
authors.lastname: Yadav
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D001026:Coronary Artery Bypass; D003326:Coronary Circulation; D003327:Coronary Disease / Q000503:physiopathology / Q000628:therapy*; D004617:Embolism / Q000517:prevention & control*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000628:therapy*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000517:prevention & control; D012307:Risk Factors; D012501:Saphenous Vein / Q000637:transplantation; D013318:Stroke Volume