Latif, FaisalUyeda, LaurenEdson, RobertBhatt, Deepak L.Goldman, StevenHolmes, David R.Rao, Sunil V.Shunk, KendrickAggarwal, KulUretsky, BarryBolad, IslamZiada, KhaledMcFalls, EdwardIrimpen, AnandTruong, Huu TamKinlay, ScottPapademetriou, VasiliosVelagaleti, Raghava S.Rangan, Bavana V.Mavromatis, KretonShih, Mei-ChiungBanerjee, SubhashBrilakis, Emmanouil S.2021-04-292021-04-292020-02-05Latif, F., Uyeda, L., Edson, R., Bhatt, D. L., Goldman, S., Holmes, D. R., Rao, S. V., Shunk, K., Aggarwal, K., Uretsky, B., Bolad, I., Ziada, K., McFalls, E., Irimpen, A., Truong, H. T., Kinlay, S., Papademetriou, V., Velagaleti, R. S., Rangan, B. V., … Brilakis, E. S. (2020). Stent-Only Versus Adjunctive Balloon Angioplasty Approach for Saphenous Vein Graft Percutaneous Coronary Intervention. Circulation. Cardiovascular Interventions, 13(2), e008494. https://doi.org/10.1161/CIRCINTERVENTIONS.119.008494https://hdl.handle.net/1805/25806BACKGROUND: Direct stenting without pre-dilation or post-dilation has been advocated for saphenous vein graft percutaneous coronary intervention to decrease the incidence of distal embolization, periprocedural myocardial infarction, and target lesion revascularization. METHODS: We performed a post hoc analysis of patients enrolled in the DIVA (Drug-Eluting Stents Versus Bare Metal Stents in Saphenous Vein Graft Angioplasty; ) prospective, double-blind, randomized controlled trial. Patients were stratified into stent-only and balloon-stent groups. Primary end point was 12-month incidence of target vessel failure (defined as the composite of cardiac death, target vessel myocardial infarction, or target vessel revascularization). Secondary end points included all-cause death, stent thrombosis, myocardial infarction, and target lesion revascularization during follow-up. RESULTS: Of the 575 patients included in this substudy, 185 (32%) patients underwent stent-only percutaneous coronary intervention. Patients in the stent-only versus balloon-stent group had similar baseline characteristics and similar incidence of target vessel failure at 12-months (15% versus 19%; hazard ratio, 1.34 [95% CI, 0.86–2.08]; P=0.19). During long-term follow-up (median of 2.7 years), the incidence of definite stent thrombosis (1% versus 5%; hazard ratio, 9.20 [95% CI, 1.23–68.92]; P=0.0085), the composite of definite or probable stent thrombosis (5% versus 11%; hazard ratio, 2.52 [95% CI, 1.23–5.18]; P=0.009), and target vessel myocardial infarction (8% versus 14%; hazard ratio, 1.92 [95% CI, 1.08–3.40]; P=0.023) was lower in the stent-only group. Multivariable analysis showed that a higher number of years since coronary artery bypass grafting and >1 target saphenous vein graft lesions were associated with increased target vessel failure during entire follow-up, while preintervention Thrombolysis in Myocardial Infarction-3 flow was protective. CONCLUSIONS: In patients undergoing percutaneous coronary intervention of de novo saphenous vein graft lesions, there was no difference in target vessel failure at 12 months and long-term follow-up in the stent-only versus the balloon-stent group; however, the incidence of stent thrombosis was lower in the stent-only group, as was target vessel myocardial infarction.en-USangioplastydilatationincidencemyocardial infarctionstentsArticle