Contemporary Incidence and Predictors of Major Adverse Cardiac Events After Saphenous Vein Graft Intervention With Embolic Protection (an AMEthyst Trial Substudy)

Abstract

The incidence and predictors of major adverse cardiac events after percutaneous coronary intervention of saphenous vein grafts have not been evaluated in the era of routine embolic protection device (EPD) use and the current standards of antiplatelet therapy. The Assessment of the Medtronic AVE Interceptor Saphenous Vein Graft Filter System (AMEthyst) is the largest randomized trial of vein graft intervention comparing the Interceptor EPD and either the GuardWire or FilterWire EPD as the control. The baseline demographic, procedural, and clinical characteristics and the 30-day major adverse cardiac events ([MACE] death, myocardial infarction, and repeat revascularization [either surgery or percutaneous coronary intervention] of the target vessel) were recorded for 748 patients who had undergone vein graft intervention with distal embolic protection. At 30 days, MACE had occurred in 58 patients (7.8%). The univariate predictors of MACE at 30 days included plaque volume (odds ratio 1.005/mm(3), p <0.0001), target lesion length (odds ratio 1.046/mm, p <0.001), vein graft degeneration score (odds ratio 1.631, p = 0.001), coronary narrowing classification (odds ratio 1.697, p = 0.004), reference vessel diameter (odds ratio 1.689, p = 0.004), and male gender (odds ratio 2.406, p = 0.046) and was independent of device type (p = 0.74). The plaque volume was the most important and only multivariate predictor of MACE. The highest quartile of plaque volume defined a subset at particular risk, despite EPD use (MACE 15.8% vs 5.0%, p <0.001). In conclusion, in a patient population in which EPD and preprocedure thienopyridine therapy were uniformly implemented, MACE occurred with an incidence of 7.8% at 30 days. An increasing plaque volume was the most important determinant of MACE and defined a population at particular risk.