Key result
Distal filter protection in SVG intervention is linked to ~50% higher 6-month TLR rates.
Why the study?
Embolic protection during saphenous vein graft interventions using distal balloon occlusion and aspiration reduces periprocedural complications, but the effect of filter wires is expected and not well established.
Does distal filter wire protection reduce major adverse cardiac events in patients undergoing percutaneous saphenous vein graft interventions?
Cohort (n=174)
Does distal filter wire protection reduce major adverse cardiac events in patients undergoing percutaneous saphenous vein graft interventions?
Using distal filter wire protection in high-risk SVG lesions results in clinical outcomes at 6 months that are comparable to those of low-risk SVG lesions treated without protection.
May support selective filter use in high-risk SVG lesions; leaves open whether routine protection reduces events in randomized trials.
BACKGROUND: Embolic protection during SVG interventions using distal balloon occlusion and aspiration has shown to reduce periprocedural complications compared to unprotected SVG interventions. A similar effect is expected from filter wires. PATIENTS AND METHODS: A total of 174 SVG interventions carried out with (group A; n=87) or without distal filter wire protection (group B; n=87) were retrospectively matched for the location of distal graft anastomosis and analyzed for baseline and procedural characteristics, for TIMI flow grade before and after PCI, for the post-procedural CK elevation, and for major adverse cardiac events at 30 days and 6 months (primary end point). Location of distal graft anastomosis was the left anterior descending artery in 19.6%, the left diagonal branch in 6.9%, the left marginal branch in 17.2%, the left posterolateral branch in 24.2%, the mid-segment of the right coronary artery in 28.7%, and the posterior descending artery in 3.4%. RESULTS: Baseline clinical demographics showed no relevant differences between both the groups. Mean age of vein grafts was 11.7+/- 4.3 years in group A versus 10.6+/- 4.9 years in group B (P=0.15). The number of stents per lesion was 1.4+/- 0.8 in group A versus 1.0+/- 0.8 in group B (P<0.01). The total length of stents was 32.2+/- 16.2 mm in group A versus 20.9+/-12.1 mm in group B (P<0.01). TIMI flow grade pre was 2.5+/-0.8 in group A versus 2.7+/- 0.6 in group B (P<0.05). TIMI flow grade post was 2.9+/- 0.3 versus 2.9+/- 0.2. Improvement of TIMI flow grade after SVG intervention was 0.4+/- 0.7 in group A versus 0.2+/- 0.6 in group B (P<0.05). Post-procedural CK-MB elevations were observed in 17 patients of group A versus 14 patients of group B (P=0.18). At 30 days, there were no myocardial infarctions (MIs) and no deaths in either group. One patient of group A had to be reoperated and four patients of group A underwent repeat PCI (4.6%) versus one patient of group B (1.2%). At 6 months, there were again no MIs and no deaths in either group. Target lesion revascularization rate was 17.3% in group A versus 11.5% in group B (P <0.02). CONCLUSION: When distal filter wire protection is used in high risk SVG lesions, the clinical outcome of percutaneous interventions may be equal to low risk SVG lesions without filter wire protection.
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Hofmann et al. (2005) conducted a cohort in Saphenous vein graft lesions (n=174). Distal filter wire protection vs. No distal filter wire protection was evaluated on major adverse cardiac events at 30 days and 6 months. In patients undergoing saphenous vein graft interventions, distal filter wire protection was associated with a 6-month target lesion revascularization rate of 17.3% compared to 11.5% without protection (P<0.02).
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