Embolic protection device use and its association with procedural safety and long-term outcomes following saphenous vein graft intervention: An analysis from the British Columbia Cardiac registry.
BACKGROUND
Embolic protection devices (EPDs) have been designed and introduced to reduce distal embolization and peri-procedural myocardial infarction during saphenous vein graft (SVG) intervention. Current guidelines give a class I recommendation to EPD use during SVG intervention when technically feasible. However, the routine use of these devices has recently been debated.


METHODS
We analyzed 1,359 patients undergoing isolated SVG intervention between 2008 and 2013 in the British Columbia Cardiac Registry. We analyzed (a) post-procedural TIMI flow; and (b) target vessel revascularization (TVR) and mortality at 1 and 2 years.


RESULTS
EPD use was an independent predictor of post-procedural TIMI 2/3 flow (OR = 2.38, 95% CI: 1.51-3.74, P < 0.001). At 1 year, EPD use was an independent predictor for lower TVR (HR = 0.35, 95% CI: 0.14-0.85, P = 0.021) and a trend towards lower mortality (HR = 0.45, 95% CI: 0.18-1.10, P = 0.082). These associations were lost at 2 years where EPD use was not predictive of mortality (HR = 0.62, 95% CI: 0.33-1.17, P = 0.144) or TVR (HR = 0.70, 95% CI: 0.41-1.17, P = 0.176). These findings were confirmed in propensity-matched and inverse probability treatment weighted analyses.


CONCLUSIONS
In this analysis of patients undergoing SVG intervention, EPD use was a strong predictor for improved post-procedural TIMI flow. Whilst EPD use was associated with lower TVR and a trend for lower mortality at 1 year, these associations were lost at 2 years. These findings would appear to support the use of EPD for SVG intervention. © 2015 Wiley Periodicals, Inc.
Victoria Heart Institute Foundation, Victoria, British Columbia, Canada.|Royal Jubilee Hospital, Victoria, British Columbia, Canada.
M Bilal
MB
Iqbal
Victoria Heart Institute Foundation, Victoria, British Columbia, Canada.|Royal Jubilee Hospital, Victoria, British Columbia, Canada.
Imad J
IJ
Nadra
Provincial Health Services Authority, Vancouver, British Columbia, Canada.
Lillian
L
Ding
Vancouver General Hospital, Vancouver, British Columbia, Canada.
Anthony
A
Fung
St. Paul's Hospital, Vancouver, British Columbia, Canada.
Eve
E
Aymong
Royal Columbian Hospital, Vancouver, British Columbia, Canada.
Albert W
AW
Chan
Kelowna General Hospital, Kelowna, British Columbia, Canada.
Steven
S
Hodge
Victoria Heart Institute Foundation, Victoria, British Columbia, Canada.|Royal Jubilee Hospital, Victoria, British Columbia, Canada.
Anthony
A
Della Siega
Victoria Heart Institute Foundation, Victoria, British Columbia, Canada.|Royal Jubilee Hospital, Victoria, British Columbia, Canada.
Simon D
SD
Robinson
D000368:Aged; D000369:Aged, 80 and over; D001955:British Columbia; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D003326:Coronary Circulation; D057505:Embolic Protection Devices; D004617:Embolism / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D057216:Propensity Score; D016016:Proportional Hazards Models; D065840:Protective Factors; D012039:Regional Blood Flow; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012501:Saphenous Vein / Q000503:physiopathology / Q000637:transplantation*; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency
embolic protection device; mortality; post-procedural flow; saphenous vein graft; target vessel revascularization