title: Early and midterm major adverse cardiac events in patient with saphenous vein graft using direct stenting or embolic protection device stenting.
abstract: BACKGROUND
  The treatment of an occluded saphenous vein graft (SVG) with percutaneous coronary intervention may encounter major adverse cardiac events (MACE). MACE rates have been reduced significantly by using the embolic protection device (EPD).
  
  
  OBJECTIVE
  The aim of this study was to clarify the risks and the benefits of embolic protection devices.
  
  
  METHODS
  In a prospective, non-randomized observational study, patients aged 33 to 85 years old who underwent elective percutaneous coronary intervention due to SVG stenosis at our tertiary care center were enrolled between 2009 and 2011. The incidence rates of adverse events, including MACE, were obtained during the patients' hospitalization and at 30-day and 6-month follow-up. MACE included death, Q-wave and non-Q-wave myocardial infarction, in-stent thrombosis, target lesion revascularization, and target vessel revascularization.
  
  
  RESULTS
  From 150 patients enrolled to the study, 128 (85.3%) patients underwent direct stenting and the rest underwent the EPD procedure. In-hospital MACE occurred in 17.2% of the patients in the direct stenting group versus only 9.1% in the EPD group (P = 0.530). MACE incidence was gradually increased at one and 6-month follow-up periods in the direct stenting group (19.5% and 21.9%, respectively), and remained unchanged in the EPD group (9.1% at six-month follow-up). Multivariate logistic regression model showed that the stenting procedure type could not predict early and midterm MACE with the presence of baseline characteristics as cofounders.
  
  
  CONCLUSIONS
  Despite the considerable lower early and midterm MACE rates, numerically following the EPD procedure compared to direct stenting, the difference in the MACE rates between the two groups was not significant.
authors.affiliation: Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Mohammadali
authors.initials: M
authors.lastname: Sadr-Ameli
authors.affiliation: Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Hossein
authors.initials: H
authors.lastname: Mousavi
authors.affiliation: Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Mona
authors.initials: M
authors.lastname: Heidarali
authors.affiliation: Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Maadani
authors.affiliation: Department of Intervention, 502 Military Hospital, Tehran, IR Iran.
authors.forename: Yones
authors.initials: Y
authors.lastname: Ghelich
authors.affiliation: Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Behshid
authors.initials: B
authors.lastname: Ghadrdoost
keywords: Blood Vessels; Coronary Artery Bypass; Embolic Protection Devices; Lesion; Saphenous Vein; Transplants