{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:55:33Z","timestamp":1788310533222,"version":"build-2803163510"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Interventions"],"published-print":{"date-parts":[[2015,3]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>Information is limited on contemporary use and outcomes of embolic protection devices (EPDs) in saphenous vein graft interventions.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              We formed a longitudinal cohort (2005\u20132009; n=49 325) by linking National Cardiovascular Data Registry CathPCI Registry to Medicare claims to examine the association between EPD use and both procedural and long-term outcomes among seniors (65+ years), adjusting for clinical factors using propensity and instrumental variable methodologies. Prespecified high-risk subgroups included acute coronary syndrome and de novo or graft body lesions. EPDs were used in 21.2% of saphenous vein grafts (median age, 75; 23% women) and were more common in acute coronary syndrome (versus non\u2013acute coronary syndrome; 22% versus 19%), de novo (versus restenotic; 22% versus 14%), and graft body lesions (versus aortic and distal anastomosis; 24% versus 20% versus 8%, respectively). EPDs were associated with a slightly higher incidence of procedural complications, including no reflow (3.9% versus 2.8%;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001), vessel dissection (1.3% versus 1.1%;\n              <jats:italic>P<\/jats:italic>\n              =0.05), perforation (0.7% versus 0.4%;\n              <jats:italic>P<\/jats:italic>\n              =0.001), and periprocedural myocardial infarction (2.8% versus 1.8%;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). By 3 years, death, myocardial infarction, and repeat revascularization occurred in 25%, 15%, and 30% of cases, respectively. EPD use was associated with a similar adjusted risk of death (propensity score\u2013matched hazard ratio, 0.96; 95% confidence interval, 0.91\u20131.02), myocardial infarction (propensity score\u2013matched hazard ratio, 1.00; 95% confidence interval, 0.93\u20131.09), and repeat revascularization (propensity score\u2013matched hazard ratio, 1.02; 95% confidence interval, 0.96\u20131.08) in the overall cohort and high-risk subgroups.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>In this contemporary cohort, EPDs were used more commonly among patients with high-risk clinical indications, yet there was no evidence of improved acute- or long-term outcomes. Further prospective studies are needed to support routine EPD use.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circinterventions.114.001403","type":"journal-article","created":{"date-parts":[[2015,2,26]],"date-time":"2015-02-26T09:04:40Z","timestamp":1424941480000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":52,"title":["Three-Year Outcomes Associated With Embolic Protection in Saphenous Vein Graft Intervention"],"prefix":"10.1161","volume":"8","author":[{"given":"J. Matthew","family":"Brennan","sequence":"first","affiliation":[{"name":"From the Duke Clinical Research Institute, Durham, NC (J.M.B., W.A.-H., D.D., S.V.R., K.J.A., E.D.P., P.S.D., M.H.S.); Sutter Pacific Heart Centers, San Francisco, CA (R.E.S.); Carolina Pacific Medical Center, San Francisco, CA (M.T.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (E.S.B.); and Denver Veterans Affairs Medical Center, CO (J.C.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wesam","family":"Al-Hejily","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute, Durham, NC (J.M.B., W.A.-H., D.D., S.V.R., K.J.A., E.D.P., P.S.D., M.H.S.); Sutter Pacific Heart Centers, San Francisco, CA (R.E.S.); Carolina Pacific Medical Center, San Francisco, CA (M.T.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (E.S.B.); and Denver Veterans Affairs Medical Center, CO (J.C.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Dai","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute, Durham, NC (J.M.B., W.A.-H., D.D., S.V.R., K.J.A., E.D.P., P.S.D., M.H.S.); Sutter Pacific Heart Centers, San Francisco, CA (R.E.S.); Carolina Pacific Medical Center, San Francisco, CA (M.T.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (E.S.B.); and Denver Veterans Affairs Medical Center, CO (J.C.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard E.","family":"Shaw","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute, Durham, NC (J.M.B., W.A.-H., D.D., S.V.R., K.J.A., E.D.P., P.S.D., M.H.S.); Sutter Pacific Heart Centers, San Francisco, CA (R.E.S.); Carolina Pacific Medical Center, San Francisco, CA (M.T.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (E.S.B.); and Denver Veterans Affairs Medical Center, CO (J.C.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Trilesskaya","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute, Durham, NC (J.M.B., W.A.-H., D.D., S.V.R., K.J.A., E.D.P., P.S.D., M.H.S.); Sutter Pacific Heart Centers, San Francisco, CA (R.E.S.); Carolina Pacific Medical Center, San Francisco, CA (M.T.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (E.S.B.); and Denver Veterans Affairs Medical Center, CO (J.C.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunil V.","family":"Rao","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute, Durham, NC (J.M.B., W.A.-H., D.D., S.V.R., K.J.A., E.D.P., P.S.D., M.H.S.); Sutter Pacific Heart Centers, San Francisco, CA (R.E.S.); Carolina Pacific Medical Center, San Francisco, CA (M.T.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (E.S.B.); and Denver Veterans Affairs Medical Center, CO (J.C.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanouil S.","family":"Brilakis","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute, Durham, NC (J.M.B., W.A.-H., D.D., S.V.R., K.J.A., E.D.P., P.S.D., M.H.S.); Sutter Pacific Heart Centers, San Francisco, CA (R.E.S.); Carolina Pacific Medical Center, San Francisco, CA (M.T.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (E.S.B.); and Denver Veterans Affairs Medical Center, CO (J.C.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin J.","family":"Anstrom","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute, Durham, NC (J.M.B., W.A.-H., D.D., S.V.R., K.J.A., E.D.P., P.S.D., M.H.S.); Sutter Pacific Heart Centers, San Francisco, CA (R.E.S.); Carolina Pacific Medical Center, San Francisco, CA (M.T.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (E.S.B.); and Denver Veterans Affairs Medical Center, CO (J.C.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C.","family":"Messenger","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute, Durham, NC (J.M.B., W.A.-H., D.D., S.V.R., K.J.A., E.D.P., P.S.D., M.H.S.); Sutter Pacific Heart Centers, San Francisco, CA (R.E.S.); Carolina Pacific Medical Center, San Francisco, CA (M.T.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (E.S.B.); and Denver Veterans Affairs Medical Center, CO (J.C.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric D.","family":"Peterson","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute, Durham, NC (J.M.B., W.A.-H., D.D., S.V.R., K.J.A., E.D.P., P.S.D., M.H.S.); Sutter Pacific Heart Centers, San Francisco, CA (R.E.S.); Carolina Pacific Medical Center, San Francisco, CA (M.T.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (E.S.B.); and Denver Veterans Affairs Medical Center, CO (J.C.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela S.","family":"Douglas","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute, Durham, NC (J.M.B., W.A.-H., D.D., S.V.R., K.J.A., E.D.P., P.S.D., M.H.S.); Sutter Pacific Heart Centers, San Francisco, CA (R.E.S.); Carolina Pacific Medical Center, San Francisco, CA (M.T.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (E.S.B.); and Denver Veterans Affairs Medical Center, CO (J.C.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"Michael H.","family":"Sketch","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute, Durham, NC (J.M.B., W.A.-H., D.D., S.V.R., K.J.A., E.D.P., P.S.D., M.H.S.); Sutter Pacific Heart Centers, San Francisco, CA (R.E.S.); Carolina Pacific Medical Center, San Francisco, CA (M.T.); Veterans Affairs North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas (E.S.B.); and Denver Veterans Affairs Medical Center, CO (J.C.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000012783.63093.0C"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.23438"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.23471"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)61255-5"},{"key":"e_1_3_4_6_2","first-page":"49","article-title":"Clinical and economic outcomes of embolic complications and strategies for distal embolic protection during percutaneous coronary intervention in saphenous vein grafts.","volume":"18","author":"Senter SR","year":"2006","unstructured":"Senter SR, Nathan S, Gupta A, Klein LW. Clinical and economic outcomes of embolic complications and strategies for distal embolic protection during percutaneous coronary intervention in saphenous vein grafts. J Invasive Cardiol. 2006;18:49\u201353.","journal-title":"J Invasive Cardiol"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2011.05.014"},{"key":"e_1_3_4_8_2","first-page":"4","article-title":"Embolic protection devices in saphenous vein graft interventions: is there still a role?","volume":"24","author":"Narayanan A","year":"2012","unstructured":"Narayanan A, Abdallah M, Helmy T. Embolic protection devices in saphenous vein graft interventions: is there still a role? 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Pretreatment with intragraft verapamil prior to percutaneous coronary intervention of saphenous vein graft lesions: results of the randomized, controlled vasodilator prevention on no-reflow (VAPOR) trial. J Invasive Cardiol. 2002;14:299\u2013302.","journal-title":"J Invasive Cardiol"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.21678"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2009.12.004"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2008.01.002"},{"key":"e_1_3_4_26_2","doi-asserted-by":"publisher","DOI":"10.2459\/JCM.0b013e328347c3aa"},{"key":"e_1_3_4_27_2","first-page":"244","article-title":"Histopathology of material captured by embolic protection device after percutaneous coronary interventions in atherosclerotic saphenous vein grafts.","volume":"2","author":"Steigen SE","year":"2006","unstructured":"Steigen SE, Steigen TK, Gunnes P, Thuesen L, Mannsverk J, J\u00f8rgensen L. 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