Kirtane Ajay J, Heyman Eugene R, Metzger Christopher, Breall Jeffrey A, Carrozza Joseph P
Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, New York, USA.
JACC Cardiovasc Interv. 2008 Apr;1(2):186-91. doi: 10.1016/j.jcin.2008.01.002.
We sought to identify correlates of 30-day adverse events among patients undergoing percutaneous coronary intervention (PCI) of saphenous vein grafts (SVG).
Although the use of distal embolic protection devices during SVG intervention reduces major adverse cardiac events (MACE), many patients still experience MACE despite distal embolic protection, and the major predictors of MACE among these patients are not well-characterized.
Correlates of 30-day MACE and peri-procedural creatine kinase-myocardial band (CK-MB) elevation were assessed among 631 patients undergoing SVG intervention with distal embolic protection enrolled in the PRIDE (PRotection during saphenous vein graft Intervention to prevent Distal Embolization) study, a randomized comparison of the TriActiv System (Kensey-Nash Corp., Exton, Pennsylvania) with an active control group (Guardwire [Medtronic, Santa Clara, California] or Filterwire [Boston Scientific, Minneapolis, Minnesota]).
Baseline covariates associated with MACE were longer lesion length, greater angiographically assessed estimated plaque volume, and higher SVG degeneration score. Graft age and angina class were not associated with adverse events. Angiographic lesion length was significantly correlated with more complex angiographic metrics such as estimated plaque volume and the SVG degeneration score. In multivariable analyses, angiographic lesion length was the strongest independent correlate of MACE (odds ratio [OR] 2.81 [95% confidence interval (CI) 1.82 to 4.34]/log-increase in lesion length, p < 0.001) with a graded increase in MACE observed with increasing lesion lengths. Similarly, the strongest independent correlate of CK-MB elevation was lesion length (OR 2.54 [95% CI 1.59 to 4.04]/log-increase in lesion length, p < 0.001). The associations between lesion length and both MACE and CK-MB elevation were consistent among the studied embolic protection devices (TriActiv, Guardwire, or Filterwire).
Angiographic lesion length was the strongest correlate of short-term adverse events among patients undergoing SVG intervention with distal embolic protection, with incremental effects noted at even relatively short lesion lengths.
我们试图确定接受大隐静脉桥血管（SVG）经皮冠状动脉介入治疗（PCI）的患者30天不良事件的相关因素。
尽管在SVG介入治疗期间使用远端栓塞保护装置可减少主要不良心脏事件（MACE），但许多患者尽管有远端栓塞保护仍会发生MACE，且这些患者中MACE的主要预测因素尚未得到充分描述。
在参与PRIDE（大隐静脉桥血管介入治疗期间预防远端栓塞的保护）研究的631例接受远端栓塞保护的SVG介入治疗患者中，评估30天MACE和围手术期肌酸激酶-心肌型（CK-MB）升高的相关因素。该研究是TriActiv系统（肯西-纳什公司，宾夕法尼亚州埃克斯顿）与一个活性对照组（Guardwire[美敦力公司，加利福尼亚州圣克拉拉]或Filterwire[波士顿科学公司，明尼苏达州明尼阿波利斯]）的随机对照研究。
与MACE相关的基线协变量为病变长度更长、血管造影评估的估计斑块体积更大以及SVG退变评分更高。移植血管年龄和心绞痛分级与不良事件无关。血管造影病变长度与更复杂的血管造影指标如估计斑块体积和SVG退变评分显著相关。在多变量分析中，血管造影病变长度是MACE最强的独立相关因素（优势比[OR]2.81[95%置信区间（CI）1.82至4.34]/病变长度每增加一个对数单位，p<0.001），且随着病变长度增加，MACE呈分级增加。同样，CK-MB升高最强的独立相关因素是病变长度（OR 2.54[95%CI 1.59至4.04]/病变长度每增加一个对数单位，p<0.001）。病变长度与MACE和CK-MB升高之间的关联在所研究的栓塞保护装置（TriActiv、Guardwire或Filterwire）中是一致的。
在接受远端栓塞保护的SVG介入治疗的患者中，血管造影病变长度是短期不良事件最强的相关因素，即使在相对较短的病变长度时也有递增效应。
