Back to Search
Start Over
Stent-Only Versus Adjunctive Balloon Angioplasty Approach for Saphenous Vein Graft Percutaneous Coronary Intervention
- Source :
- Circ Cardiovasc Interv
- Publication Year :
- 2020
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2020.
-
Abstract
- 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.
- Subjects :
- 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
Subjects
Details
- ISSN :
- 19417632 and 19417640
- Volume :
- 13
- Database :
- OpenAIRE
- Journal :
- Circulation: Cardiovascular Interventions
- Accession number :
- edsair.doi.dedup.....3c4091845fb20a0a8226d4757ddc2d76
- Full Text :
- https://doi.org/10.1161/circinterventions.119.008494