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Three-year outcomes associated with embolic protection in saphenous vein graft intervention: results in 49 325 senior patients in the Medicare-linked National Cardiovascular Data Registry CathPCI Registry.

Publication ,  Journal Article
Brennan, JM; Al-Hejily, W; Dai, D; Shaw, RE; Trilesskaya, M; Rao, SV; Brilakis, ES; Anstrom, KJ; Messenger, JC; Peterson, ED; Douglas, PS; Sketch, MH
Published in: Circ Cardiovasc Interv
March 2015

BACKGROUND: Information is limited on contemporary use and outcomes of embolic protection devices (EPDs) in saphenous vein graft interventions. METHODS AND RESULTS: We formed a longitudinal cohort (2005-2009; n=49 325) by linking National Cardiovascular Data Registry CathPCI Registry to Medicare claims to examine the association between EPD use and both procedural and long-term outcomes among seniors (65+ years), adjusting for clinical factors using propensity and instrumental variable methodologies. Prespecified high-risk subgroups included acute coronary syndrome and de novo or graft body lesions. EPDs were used in 21.2% of saphenous vein grafts (median age, 75; 23% women) and were more common in acute coronary syndrome (versus non-acute coronary syndrome; 22% versus 19%), de novo (versus restenotic; 22% versus 14%), and graft body lesions (versus aortic and distal anastomosis; 24% versus 20% versus 8%, respectively). EPDs were associated with a slightly higher incidence of procedural complications, including no reflow (3.9% versus 2.8%; P<0.001), vessel dissection (1.3% versus 1.1%; P=0.05), perforation (0.7% versus 0.4%; P=0.001), and periprocedural myocardial infarction (2.8% versus 1.8%; P<0.001). By 3 years, death, myocardial infarction, and repeat revascularization occurred in 25%, 15%, and 30% of cases, respectively. EPD use was associated with a similar adjusted risk of death (propensity score-matched hazard ratio, 0.96; 95% confidence interval, 0.91-1.02), myocardial infarction (propensity score-matched hazard ratio, 1.00; 95% confidence interval, 0.93-1.09), and repeat revascularization (propensity score-matched hazard ratio, 1.02; 95% confidence interval, 0.96-1.08) in the overall cohort and high-risk subgroups. CONCLUSIONS: In this contemporary cohort, EPDs were used more commonly among patients with high-risk clinical indications, yet there was no evidence of improved acute- or long-term outcomes. Further prospective studies are needed to support routine EPD use.

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Published In

Circ Cardiovasc Interv

DOI

EISSN

1941-7632

Publication Date

March 2015

Volume

8

Issue

3

Start / End Page

e001403

Location

United States

Related Subject Headings

  • Vascular Grafting
  • United States
  • Treatment Outcome
  • Saphenous Vein
  • Registries
  • Medicare
  • Male
  • Longitudinal Studies
  • Humans
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Brennan, J. M., Al-Hejily, W., Dai, D., Shaw, R. E., Trilesskaya, M., Rao, S. V., … Sketch, M. H. (2015). Three-year outcomes associated with embolic protection in saphenous vein graft intervention: results in 49 325 senior patients in the Medicare-linked National Cardiovascular Data Registry CathPCI Registry. Circ Cardiovasc Interv, 8(3), e001403. https://doi.org/10.1161/CIRCINTERVENTIONS.114.001403
Brennan, J Matthew, Wesam Al-Hejily, David Dai, Richard E. Shaw, Marina Trilesskaya, Sunil V. Rao, Emmanouil S. Brilakis, et al. “Three-year outcomes associated with embolic protection in saphenous vein graft intervention: results in 49 325 senior patients in the Medicare-linked National Cardiovascular Data Registry CathPCI Registry.Circ Cardiovasc Interv 8, no. 3 (March 2015): e001403. https://doi.org/10.1161/CIRCINTERVENTIONS.114.001403.
Brennan, J. Matthew, et al. “Three-year outcomes associated with embolic protection in saphenous vein graft intervention: results in 49 325 senior patients in the Medicare-linked National Cardiovascular Data Registry CathPCI Registry.Circ Cardiovasc Interv, vol. 8, no. 3, Mar. 2015, p. e001403. Pubmed, doi:10.1161/CIRCINTERVENTIONS.114.001403.
Brennan JM, Al-Hejily W, Dai D, Shaw RE, Trilesskaya M, Rao SV, Brilakis ES, Anstrom KJ, Messenger JC, Peterson ED, Douglas PS, Sketch MH. Three-year outcomes associated with embolic protection in saphenous vein graft intervention: results in 49 325 senior patients in the Medicare-linked National Cardiovascular Data Registry CathPCI Registry. Circ Cardiovasc Interv. 2015 Mar;8(3):e001403.

Published In

Circ Cardiovasc Interv

DOI

EISSN

1941-7632

Publication Date

March 2015

Volume

8

Issue

3

Start / End Page

e001403

Location

United States

Related Subject Headings

  • Vascular Grafting
  • United States
  • Treatment Outcome
  • Saphenous Vein
  • Registries
  • Medicare
  • Male
  • Longitudinal Studies
  • Humans
  • Female