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Thrombus predicts ischemic complications during percutaneous coronary intervention in saphenous vein grafts: Results from TARGET (do tirofiban and reopro give similar efficacy trial?)
Author(s) -
Kalyanasundaram Arun,
Blankenship James C.,
Berger Peter,
Herrmann Howard,
McClure Rick,
Moliterno David
Publication year - 2006
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.20963
Subject(s) - medicine , abciximab , percutaneous coronary intervention , mace , tirofiban , conventional pci , cardiology , myocardial infarction , odds ratio , timi , clinical endpoint , surgery , randomized controlled trial
Background : Saphenous vein graft (SVG) percutaneous coronary intervention (PCI) carries a high risk of ischemic complications. However, there are scant recent data to identify which SVG lesions carry particularly high risk in recent years. We studied demographic and angiographic factors associated with ischemic complications after SVG PCI without distal protection in the TARGET (do tirofiban and reopro give similar efficacy trial?) study. Methods : TARGET was a multicenter double‐dummy, double‐blinded study randomizing 4,809 PCI patients to tirofiban or abciximab. Of these, 254 patients underwent PCI involving an SVG lesion. The primary endpoint of this analysis was major adverse cardiac events (MACEs) at 30 days, including death, nonfatal myocardial infarction (MI), and urgent target vessel revascularization. Results : No demographic characteristic was associated with 30‐day MACE. Lesion length > 20 mm (odds ratio [OR] = 2.7, P = 0.03), thrombus (OR = 3.9, P = 0.003), eccentricity ( P = 0.001), thrombolysis in myocardial infarction flow < 3 postprocedure (OR = 5.6, P = 0.037), and >1 target lesion (OR = 2.5, P = 0.035) were univariate variables associated with 30‐day MACE. Multivariate analysis associated only thrombus (OR = 3.8, P = 0.015) with 30‐day MACE. No difference in outcomes was noted between patients receiving abciximab and tirofiban. SVG patients had lesser angiographic success (95.6% vs. 98%, P = 0.04) and increased 30‐day Q‐wave MI (2.5% vs. 0.9%, P = 0.039) compared with non‐SVG patients, but a similar incidence of death (0% vs. 0.4%), non‐Q‐MI (5.9% vs. 4.5%), and target vessel revascularization (0.5% vs. 1%). Conclusion : In the era of routine stenting and GpIIb/IIIa inhibitors, thrombus is the angiographic characteristic most closely associated with adverse outcomes of SVG PCI © 2006 Wiley‐Liss, Inc.