In‐hospital outcomes and usage of embolic protection devices in percutaneous coronary intervention for coronary artery bypass grafts: Insights from a Japanese nationwide registry

Abstract

AbstractObjectivesWe evaluated the in‐hospital outcomes of percutaneous coronary intervention (PCI) for bypass graft vessels (GV‐PCI) compared with those of PCI for native vessels (NV‐PCI) using data from the Japanese nationwide coronary intervention registry.MethodsWe included PCI patients (N = 748,229) registered between January 2016 and December 2018 from 1,123 centers. We divided patients into three groups: GV‐PCI (n = 2,745); NV‐PCI with a prior coronary artery bypass graft (pCABG) (n = 23,932); and NV‐PCI without pCABG (n = 721,552).ResultsGV‐PCI implementation was low, and most cases of PCI in pCABG patients were performed in native vessels (89.7%) in contemporary Japanese practice. The risk profile of patients with pCABG was higher than that of those without pCABG. Consequently, GV‐PCI patients had a significantly higher in‐hospital mortality than NV‐PCI patients without pCABG after adjusting for covariates (odds ratio [OR] 2.36, 95% confidence interval [CI] 1.66–3.36, p < .001). Of note, embolic protection devices (EPDs) were used in 18% (n = 383) of PCIs for saphenous vein grafts (SVG‐PCI) with a significant variation in its use among institutions (number of PCI: hospitals that had never used an EPD vs. EPD used one or more times = 240 vs. 345, p < .001). The EPDs used in the SVG‐PCI group had a significantly lower prevalence of the slow‐flow phenomenon after adjusting for covariates (OR 0.45, 95% CI 0.21–0.91, p = .04).ConclusionGV‐PCI is associated with an increased risk of in‐hospital mortality. EDP use in SVG‐PCI was associated with a low rate of the slow‐flow phenomenon. The usage of EPDs during SVG‐PCI is low, with a significant variation among institutions.