Long-Term Clinical Outcomes After Filter Protection During Percutaneous Coronary Intervention in Patients With Attenuated Plaque　― 1-Year Follow up of the VAMPIRE 3 (Vacuum Aspiration Thrombus Reemoval 3) Trial

• Published in: Circulation Journal Vol. 85; no. 1; pp. 44 - 49
• Main Authors: Hibi, Kiyoshi, Kozuma, Ken, Maejima, Nobuhiko, Sonoda, Shinjo, Endo, Tsutomu, Tanaka, Hiroyuki, Kyono, Hiroyuki, Koshida, Ryoji, Ishihara, Takayuki, Awata, Masaki, Kume, Teruyoshi, Tanabe, Kengo, Morino, Yoshihiro, Tsukahara, Kengo, Ikari, Yuji, Fujii, Kenshi, Yamasaki, Masao, Yamanaka, Takeharu, Sumiyoshi, Tetsuya, Yoshino, Hideaki, Kimura, Kazuo, Isshiki, Takaaki, for the VAMPIRE 3 Investigators
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 25-12-2020
• Subjects: Acute Coronary Syndrome - surgery; Acute coronary syndromes; Distal embolism; Distal protection device; Follow-Up Studies; Humans; Intravascular ultrasonography; Percutaneous Coronary Intervention; Plaque, Atherosclerotic; Thrombosis; Treatment Outcome; Vacuum Curettage; Distal embolism; Intravascular ultrasonography; Acute coronary syndromes; Distal protection device
• ISSN: 1346-9843; 1347-4820; 1347-4820
• DOI: 10.1253/circj.CJ-20-0449

Background:Selective use of distal filter protection during percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS) decreased the incidence of no-reflow phenomena and in-hospital serious adverse cardiac events compared with conventional PCI in patients with attenuated plaque ≥5 mm; however, its long-term clinical outcome remains unknown.Methods and Results:Patients who had ACS with attenuated plaque ≥5 mm were assigned to receive distal protection (DP) (n=98) or conventional treatment (CT) (n=96). The rate of major adverse cardiovascular events (MACE), a composite of death from any cause, non-fatal myocardial infarction, or target vessel revascularization (TVR) at 1 year, was the pre-specified secondary endpoint of the trial. MACE at 1 year occurred in 12 patients (12.2%) in the DP group and 3 patients (3.1%) in the CT group (P=0.029), which was driven by a higher risk of TVR (11 [11.2%] vs. 2 [2.1%], P=0.018). In patients treated with bare-metal stents (n=42), MACE occurred in 25.0% of the patients in the DP group and in none of the patients in the CT group (P=0.029), whereas in patients treated with drug-eluting stents (n=151), rates of MACE were similar in the groups (8.1% vs. 3.9%, P=0.32).Conclusions:In ACS patients with attenuated plaque ≥5 mm, the 1-year rates of MACE were higher in the DP group than in the CT group. This effect might be mitigated by the use of drug-eluting stents.