title: Saphenous vein graft stenting and major adverse cardiac events: a predictive model derived from a pooled analysis of 3958 patients.
abstract: 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.
  
  
  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.
authors.affiliation: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass 02115, USA.
authors.forename: Alanna
authors.initials: A
authors.lastname: Coolong
authors.forename: Donald S
authors.initials: DS
authors.lastname: Baim
authors.forename: Richard E
authors.initials: RE
authors.lastname: Kuntz
authors.forename: A James
authors.initials: AJ
authors.lastname: O'Malley
authors.forename: Sachin
authors.initials: S
authors.lastname: Marulkar
authors.forename: Donald E
authors.initials: DE
authors.lastname: Cutlip
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Popma
authors.forename: Laura
authors.initials: L
authors.lastname: Mauri
mesh_terms: D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary; D001499:Bayes Theorem; D017023:Coronary Angiography; D003327:Coronary Disease / Q000401:mortality* / Q000601:surgery / Q000628:therapy; D006083:Graft Occlusion, Vascular / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology; D018570:Risk Assessment / Q000379:methods*; D012501:Saphenous Vein / Q000473:pathology / Q000637:transplantation*; D015607:Stents