Saphenous vein graft (SVG) percutaneous intervention (PCI) with and without embolic protection devices (EPDs).

Abstract

Background: PCI of a SVG is often complex with a high rate of distal embolisation and no-reflow phenomenon, resulting in a double 30-day major adverse cardiac and cerebrovascular event (MACCE) rate compared to native vessel PCI. EPDs have been developed to offset these risks. The PROXIMAL, SAFER and FIRE studies all demonstrated MACCE rates of 5%–10%, compared to 15%–20% for unprotected SVG PCI. We sought to assess the proportion of SVG PCI cases where EPD was used and compare the 30-day MACCE and one-year mortality of EPD-guided SVG PCI versus unprotected SVG PCI. Methods: Retrospective review of all patients who have undergone PCI to an SVG utilising the MIG registry. Results: Between 2005–2020, 753 patients underwent PCI to an SVG, of which 256 patients had EPDs (40.0%), with a FilterWire the predominant EPD used (95.6%). On an annual basis, the number of SVG PCIs decreased from 2005 to 2020 and the use of EPD devices declined from 58.3% of all SVG PCI in 2008 to 14.8% in 2020. Peri-procedural complications (3.7%), TIMI 3 flow (96.8%), and no-reflow phenomenon (1.2%) were similar between the two groups. 30-day MACCE was similar between the two groups (2.6% vs 1.2%, p=0.19). There was no significant difference in 12-month mortality (4.4% vs 4.7%, p=0.86). Conclusions: EPD-guided PCI of the SVG was not advantageous for 12-month survival or 30-day MACCE but the MACCE for unprotected SVG PCI was lower than previously reported. Rates of both SVG PCI and EPDs are declining over time.