Stent-Only Versus Adjunctive Balloon Angioplasty Approach for Saphenous Vein Graft Percutaneous Coronary Intervention
| Autor: | Kreton Mavromatis, Emmanouil S. Brilakis, Islam Bolad, Robert Edson, Edward O. McFalls, Kendrick A. Shunk, Mei Chiung Shih, Faisal Latif, Subhash Banerjee, Kul Aggarwal, Lauren Uyeda, Barry F. Uretsky, Huu Tam Truong, Anand Irimpen, Steven Goldman, Bavana V. Rangan, Deepak L. Bhatt, David R. Holmes, Sunil V. Rao, Vasilios Papademetriou, Khaled M. Ziada, Raghava S. Velagaleti, Scott Kinlay |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Time Factors medicine.medical_treatment Distal embolization Saphenous vein graft Myocardial Infarction Balloon Article Double-Blind Method Risk Factors Angioplasty medicine Humans Direct stenting Saphenous Vein Prospective Studies cardiovascular diseases Myocardial infarction Angioplasty Balloon Coronary Coronary Artery Bypass Vascular Patency Aged business.industry Coronary Thrombosis Graft Occlusion Vascular Percutaneous coronary intervention Stent Middle Aged medicine.disease United States Surgery Treatment Outcome surgical procedures operative Female Stents Cardiology and Cardiovascular Medicine business |
| Zdroj: | Circ Cardiovasc Interv |
| ISSN: | 1941-7632 1941-7640 |
| Popis: | Background: Direct stenting without pre-dilation or post-dilation has been advocated for saphenous vein graft percutaneous coronary intervention to decrease the incidence of distal embolization, periprocedural myocardial infarction, and target lesion revascularization. Methods: We performed a post hoc analysis of patients enrolled in the DIVA (Drug-Eluting Stents Versus Bare Metal Stents in Saphenous Vein Graft Angioplasty; NCT 01121224) prospective, double-blind, randomized controlled trial. Patients were stratified into stent-only and balloon-stent groups. Primary end point was 12-month incidence of target vessel failure (defined as the composite of cardiac death, target vessel myocardial infarction, or target vessel revascularization). Secondary end points included all-cause death, stent thrombosis, myocardial infarction, and target lesion revascularization during follow-up. Results: Of the 575 patients included in this substudy, 185 (32%) patients underwent stent-only percutaneous coronary intervention. Patients in the stent-only versus balloon-stent group had similar baseline characteristics and similar incidence of target vessel failure at 12-months (15% versus 19%; hazard ratio, 1.34 [95% CI, 0.86–2.08]; P =0.19). During long-term follow-up (median of 2.7 years), the incidence of definite stent thrombosis (1% versus 5%; hazard ratio, 9.20 [95% CI, 1.23–68.92]; P =0.0085), the composite of definite or probable stent thrombosis (5% versus 11%; hazard ratio, 2.52 [95% CI, 1.23–5.18]; P =0.009), and target vessel myocardial infarction (8% versus 14%; hazard ratio, 1.92 [95% CI, 1.08–3.40]; P =0.023) was lower in the stent-only group. Multivariable analysis showed that a higher number of years since coronary artery bypass grafting and >1 target saphenous vein graft lesions were associated with increased target vessel failure during entire follow-up, while preintervention Thrombolysis in Myocardial Infarction-3 flow was protective. Conclusions: In patients undergoing percutaneous coronary intervention of de novo saphenous vein graft lesions, there was no difference in target vessel failure at 12 months and long-term follow-up in the stent-only versus the balloon-stent group; however, the incidence of stent thrombosis was lower in the stent-only group, as was target vessel myocardial infarction. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT 01121224. |
| Databáze: | OpenAIRE |
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