Improving the safety of angioplasty in patients with coronary bypass graft disease

October 22, 2012

Researchers at Thomas Jefferson University Hospital have shown that combining distal protection devices with the prophylactic use of the drug nicardipine is more effective at preventing life-threatening complications following a percutaneous coronary intervention (PCI) (angioplasty, stenting) on patients who have undergone previous bypass surgery than distal protection devices alone.

Their findings will be presented on Tuesday, October 23rd, at 8 a.m. at the Transcatheter Cardiovascular Therapeutics (TCT) conference, at the Miami Beach Convention Center by Michael P. Savage, MD, Director of the Cardiac Catheterization Lab at Jefferson.

Angioplasty or stenting on bypass vessels, called saphenous vein grafts, is associated with a high risk of complications due to distal embolization, the dislodging of plaque and clots downstream, impairing blood flow and leaving patients at-risk for a heart attack.

Distal protection devices are commonly used to prevent by catching the dislodged plaque and clot in a basket-like device, allowing blood to filter through the bypassed artery. Still, complications remain in up to 10 percent of patients. Preliminary studies have suggested that prophylactic doses of the drug nicardipine, a common intracoronary vasodilator, can also help in this regard, but never have the two techniques been combined.

Savage and colleagues looked at at 30 days post-PCI in 163 consecutive patients with prior . Group I consisted of 60 patients who underwent PCI using a distal protection device alone (no pre-treatment with nicardipine); Group II included 103 patients who underwent PCI with a distal protection device and pre-treatment with prophylactic nicardipine.

Both groups had similar baseline demographics including age (early 71 +/– 10 years), diabetes (47 vs. 44 percent) and bypass graft age (13 +/- 6 years). Group II had longer lesion length, requiring a longer stent and placing these patients at higher risk for complications.

At 30-days post-PCI death, heart attack, bypass or repeat PCI occurred in 10 percent of patients in Group I and in only one percent of patients in Group II. Mortality was 3.3 percent in Group I vs. zero in Group II, and incidence of MI was 10 percent in Group I vs. one percent in Group II. There was zero incidence of CABG, repeat PCI or stent thromboses in either group.

"Through the combined power of these two therapies, we have a new approach that is improving outcomes for this subset of patients," says Savage.

Explore further: Positive results for unprotected left main coronary artery PCI with drug-eluting stents

Related Stories

Positive results for unprotected left main coronary artery PCI with drug-eluting stents

June 22, 2011
Patients with normal left ventricular function who undergo elective unprotected left main coronary artery (ULMCA) percutaneous coronary intervention (PCI) with drug-eluting stents (DES) had favorable outcomes according to ...

Heart attack patients taken to PCI hospitals first treated faster

May 10, 2012
Heart attack patients in North Carolina who were rushed directly to hospitals equipped to do percutaneous coronary intervention (PCI) received treatment significantly faster than patients first taken to hospitals unequipped ...

Complications in patients undergoing percutaneous coronary intervention tend to occur within first 30 days

March 24, 2012
Percutaneous coronary intervention (PCI), also known as coronary angioplasty or angioplasty, is a procedure used to treat acute coronary syndromes. PCI involves opening a blocked blood vessel by threading and inflating a ...

Recommended for you

New discovery could reverse tissue damage caused by heart attacks

July 25, 2017
A new discovery by University of Bristol scientists helps to explain how cells which surround blood vessels, called pericytes, stimulate new blood vessels to grow with the hormone 'leptin' playing a key role. Leptin is produced ...

Could aggressive blood pressure treatments lead to kidney damage?

July 18, 2017
Aggressive combination treatments for high blood pressure that are intended to protect the kidneys may actually be damaging the organs, new research from the University of Virginia School of Medicine suggests.

Quantifying effectiveness of treatment for irregular heartbeat

July 17, 2017
In a small proof-of-concept study, researchers at Johns Hopkins report a complex mathematical method to measure electrical communications within the heart can successfully predict the effectiveness of catheter ablation, the ...

Concerns over side effects of statins stopping stroke survivors taking medication

July 17, 2017
Negative media coverage of the side effects associated with taking statins, and patients' own experiences of taking the drugs, are among the reasons cited by stroke survivors and their carers for stopping taking potentially ...

Study discovers anticoagulant drugs are being prescribed against safety advice

July 17, 2017
A study by researchers at the University of Birmingham has shown that GPs are prescribing anticoagulants to patients with an irregular heartbeat against official safety advice.

Protein may protect against heart attack

July 14, 2017
DDK3 could be used as a new therapy to stop the build-up of fatty material inside the arteries

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.