Percutaneous Coronary Intervention of Saphenous Vein Graft

Björn Redfors, Philippe Genereux, Bernhard Witzenbichler, Thomas McAndrew, Jamie Diamond, Xin Huang, Akiko Maehara, Giora Weisz, Roxana Mehran, Ajay J. Kirtane, Gregg W. Stone

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background - Percutaneous coronary intervention (PCI) of saphenous vein grafts (SVGs) has historically been associated with a high risk of adverse ischemic events, but there is a paucity of contemporary data on the second-generation drug-eluting stent use within SVG, and the relative importance of high platelet reactivity (HPR) in SVG PCI versus native lesion PCI is unknown. We studied ischemic and bleeding events after SVG PCI and their association with HPR. Methods and Results - Subjects in the prospective, multicenter ADAPT-DES study (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) were stratified according to whether they had PCI of an SVG or a non-SVG lesion. Two-year outcomes were compared between groups using univariate and multivariable Cox proportional hazards models. HPR was defined as on-clopidogrel P2Y12 platelet reaction units >208 as measured by the VerifyNow assay; major adverse cardiac events were defined as the composite of cardiac death, myocardial infarction, or stent thrombosis. Among 8582 subjects in ADAPT-DES, 405 (4.7%) had SVG PCI. SVG PCI was independently associated with a higher 2-year risk of major adverse cardiac events (adjusted hazard ratio, 2.34; 95% confidence interval, 1.69-3.23; P<0.0001), ischemia-driven target vessel revascularization (adjusted hazard ratio, 1.82; 95% confidence interval, 1.37-2.42; P<0.0001), and stent thrombosis (adjusted hazard ratio, 2.26; 95% confidence interval, 1.42-3.59; P=0.0006), but not of bleeding (adjusted hazard ratio, 0.99; 95% confidence interval, 0.68-1.46; P=0.97). There was no statistical interaction between HPR and SVG PCI in regard to major adverse cardiac events (adjusted Pinteraction=0.99). Conclusions - SVG PCI is associated with a considerably higher risk of 2-year adverse ischemic events, with HPR conferring similar risk in SVG and non-SVG PCI. More potent and longer antiplatelet therapy may be beneficial for patients undergoing SVG PCI. Clinical Trial Registration - URL: http://www.clinicaltrials.gov. Unique identifier: NCT00638794.

Original languageEnglish (US)
Article numbere004953
JournalCirculation: Cardiovascular Interventions
Volume10
Issue number5
DOIs
StatePublished - May 1 2017
Externally publishedYes

Fingerprint

Saphenous Vein
Percutaneous Coronary Intervention
Transplants
Blood Platelets
Confidence Intervals
Drug-Eluting Stents
clopidogrel
Stents
Veins
Thrombosis
Hemorrhage
Proportional Hazards Models
Ischemia
Myocardial Infarction
Clinical Trials

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Redfors, B., Genereux, P., Witzenbichler, B., McAndrew, T., Diamond, J., Huang, X., ... Stone, G. W. (2017). Percutaneous Coronary Intervention of Saphenous Vein Graft. Circulation: Cardiovascular Interventions, 10(5), [e004953]. https://doi.org/10.1161/CIRCINTERVENTIONS.117.004953
Redfors, Björn ; Genereux, Philippe ; Witzenbichler, Bernhard ; McAndrew, Thomas ; Diamond, Jamie ; Huang, Xin ; Maehara, Akiko ; Weisz, Giora ; Mehran, Roxana ; Kirtane, Ajay J. ; Stone, Gregg W. / Percutaneous Coronary Intervention of Saphenous Vein Graft. In: Circulation: Cardiovascular Interventions. 2017 ; Vol. 10, No. 5.
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abstract = "Background - Percutaneous coronary intervention (PCI) of saphenous vein grafts (SVGs) has historically been associated with a high risk of adverse ischemic events, but there is a paucity of contemporary data on the second-generation drug-eluting stent use within SVG, and the relative importance of high platelet reactivity (HPR) in SVG PCI versus native lesion PCI is unknown. We studied ischemic and bleeding events after SVG PCI and their association with HPR. Methods and Results - Subjects in the prospective, multicenter ADAPT-DES study (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) were stratified according to whether they had PCI of an SVG or a non-SVG lesion. Two-year outcomes were compared between groups using univariate and multivariable Cox proportional hazards models. HPR was defined as on-clopidogrel P2Y12 platelet reaction units >208 as measured by the VerifyNow assay; major adverse cardiac events were defined as the composite of cardiac death, myocardial infarction, or stent thrombosis. Among 8582 subjects in ADAPT-DES, 405 (4.7{\%}) had SVG PCI. SVG PCI was independently associated with a higher 2-year risk of major adverse cardiac events (adjusted hazard ratio, 2.34; 95{\%} confidence interval, 1.69-3.23; P<0.0001), ischemia-driven target vessel revascularization (adjusted hazard ratio, 1.82; 95{\%} confidence interval, 1.37-2.42; P<0.0001), and stent thrombosis (adjusted hazard ratio, 2.26; 95{\%} confidence interval, 1.42-3.59; P=0.0006), but not of bleeding (adjusted hazard ratio, 0.99; 95{\%} confidence interval, 0.68-1.46; P=0.97). There was no statistical interaction between HPR and SVG PCI in regard to major adverse cardiac events (adjusted Pinteraction=0.99). Conclusions - SVG PCI is associated with a considerably higher risk of 2-year adverse ischemic events, with HPR conferring similar risk in SVG and non-SVG PCI. More potent and longer antiplatelet therapy may be beneficial for patients undergoing SVG PCI. Clinical Trial Registration - URL: http://www.clinicaltrials.gov. Unique identifier: NCT00638794.",
author = "Bj{\"o}rn Redfors and Philippe Genereux and Bernhard Witzenbichler and Thomas McAndrew and Jamie Diamond and Xin Huang and Akiko Maehara and Giora Weisz and Roxana Mehran and Kirtane, {Ajay J.} and Stone, {Gregg W.}",
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Redfors, B, Genereux, P, Witzenbichler, B, McAndrew, T, Diamond, J, Huang, X, Maehara, A, Weisz, G, Mehran, R, Kirtane, AJ & Stone, GW 2017, 'Percutaneous Coronary Intervention of Saphenous Vein Graft', Circulation: Cardiovascular Interventions, vol. 10, no. 5, e004953. https://doi.org/10.1161/CIRCINTERVENTIONS.117.004953

Percutaneous Coronary Intervention of Saphenous Vein Graft. / Redfors, Björn; Genereux, Philippe; Witzenbichler, Bernhard; McAndrew, Thomas; Diamond, Jamie; Huang, Xin; Maehara, Akiko; Weisz, Giora; Mehran, Roxana; Kirtane, Ajay J.; Stone, Gregg W.

In: Circulation: Cardiovascular Interventions, Vol. 10, No. 5, e004953, 01.05.2017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Percutaneous Coronary Intervention of Saphenous Vein Graft

AU - Redfors, Björn

AU - Genereux, Philippe

AU - Witzenbichler, Bernhard

AU - McAndrew, Thomas

AU - Diamond, Jamie

AU - Huang, Xin

AU - Maehara, Akiko

AU - Weisz, Giora

AU - Mehran, Roxana

AU - Kirtane, Ajay J.

AU - Stone, Gregg W.

PY - 2017/5/1

Y1 - 2017/5/1

N2 - Background - Percutaneous coronary intervention (PCI) of saphenous vein grafts (SVGs) has historically been associated with a high risk of adverse ischemic events, but there is a paucity of contemporary data on the second-generation drug-eluting stent use within SVG, and the relative importance of high platelet reactivity (HPR) in SVG PCI versus native lesion PCI is unknown. We studied ischemic and bleeding events after SVG PCI and their association with HPR. Methods and Results - Subjects in the prospective, multicenter ADAPT-DES study (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) were stratified according to whether they had PCI of an SVG or a non-SVG lesion. Two-year outcomes were compared between groups using univariate and multivariable Cox proportional hazards models. HPR was defined as on-clopidogrel P2Y12 platelet reaction units >208 as measured by the VerifyNow assay; major adverse cardiac events were defined as the composite of cardiac death, myocardial infarction, or stent thrombosis. Among 8582 subjects in ADAPT-DES, 405 (4.7%) had SVG PCI. SVG PCI was independently associated with a higher 2-year risk of major adverse cardiac events (adjusted hazard ratio, 2.34; 95% confidence interval, 1.69-3.23; P<0.0001), ischemia-driven target vessel revascularization (adjusted hazard ratio, 1.82; 95% confidence interval, 1.37-2.42; P<0.0001), and stent thrombosis (adjusted hazard ratio, 2.26; 95% confidence interval, 1.42-3.59; P=0.0006), but not of bleeding (adjusted hazard ratio, 0.99; 95% confidence interval, 0.68-1.46; P=0.97). There was no statistical interaction between HPR and SVG PCI in regard to major adverse cardiac events (adjusted Pinteraction=0.99). Conclusions - SVG PCI is associated with a considerably higher risk of 2-year adverse ischemic events, with HPR conferring similar risk in SVG and non-SVG PCI. More potent and longer antiplatelet therapy may be beneficial for patients undergoing SVG PCI. Clinical Trial Registration - URL: http://www.clinicaltrials.gov. Unique identifier: NCT00638794.

AB - Background - Percutaneous coronary intervention (PCI) of saphenous vein grafts (SVGs) has historically been associated with a high risk of adverse ischemic events, but there is a paucity of contemporary data on the second-generation drug-eluting stent use within SVG, and the relative importance of high platelet reactivity (HPR) in SVG PCI versus native lesion PCI is unknown. We studied ischemic and bleeding events after SVG PCI and their association with HPR. Methods and Results - Subjects in the prospective, multicenter ADAPT-DES study (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) were stratified according to whether they had PCI of an SVG or a non-SVG lesion. Two-year outcomes were compared between groups using univariate and multivariable Cox proportional hazards models. HPR was defined as on-clopidogrel P2Y12 platelet reaction units >208 as measured by the VerifyNow assay; major adverse cardiac events were defined as the composite of cardiac death, myocardial infarction, or stent thrombosis. Among 8582 subjects in ADAPT-DES, 405 (4.7%) had SVG PCI. SVG PCI was independently associated with a higher 2-year risk of major adverse cardiac events (adjusted hazard ratio, 2.34; 95% confidence interval, 1.69-3.23; P<0.0001), ischemia-driven target vessel revascularization (adjusted hazard ratio, 1.82; 95% confidence interval, 1.37-2.42; P<0.0001), and stent thrombosis (adjusted hazard ratio, 2.26; 95% confidence interval, 1.42-3.59; P=0.0006), but not of bleeding (adjusted hazard ratio, 0.99; 95% confidence interval, 0.68-1.46; P=0.97). There was no statistical interaction between HPR and SVG PCI in regard to major adverse cardiac events (adjusted Pinteraction=0.99). Conclusions - SVG PCI is associated with a considerably higher risk of 2-year adverse ischemic events, with HPR conferring similar risk in SVG and non-SVG PCI. More potent and longer antiplatelet therapy may be beneficial for patients undergoing SVG PCI. Clinical Trial Registration - URL: http://www.clinicaltrials.gov. Unique identifier: NCT00638794.

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