Short- and Long-Term Outcomes After Stent-Assisted Percutaneous Treatment of Saphenous Vein Grafts in the Drug-Eluting Stent Era

Tereza Pucelikova, Roxana Mehran, Ajay J. Kirtane, Young Hak Kim, Martin Fahy, Giora Weisz, Alexandra J. Lansky, Issam Moussa, William A. Gray, Michael B. Collins, Susheel K. Kodali, Gregg W. Stone, Jeffrey W. Moses, Martin B. Leon, George Dangas

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37 Scopus citations

Abstract

Percutaneous treatment of saphenous vein graft (SVG) lesions has been associated with higher rates of periprocedural complications and restenosis compared with non-SVG lesions. Whether these outcomes are similar in contemporary clinical practice, particularly when drug-eluting stents are used, is unknown. We evaluated outcomes of 110 consecutive patients who were treated with stent-assisted percutaneous coronary intervention for 145 SVG lesions (drug-eluting stents used in 91.0% of lesions). Embolic protection devices were used in 52.1% of treated grafts. Adverse events were recorded up to 1 year. Major or minor periprocedural myocardial necrosis occurred in 11 patients (10.9%). At 1-year clinical follow-up, we observed 13 myocardial infarctions (13.7%), 8 target lesion revascularizations (8.4%), 18 target vessel revascularizations (19.0%), 2 stent thromboses (2.1%), and 7 deaths (7.4%). The incidence of major adverse cardiac events, defined as death, myocardial infarction, or target vessel revascularization, was 30.5% at 1 year. By multivariable analysis, the presence of thrombus inside the graft before the procedure and the length of the stented segment were independent predictors of major adverse cardiac events at 1 year (hazard ratio for thrombus 4.07, 95% confidence interval 1.90 to 8.68, p = 0.0003; hazard ratio per millimeter of stented length 1.02, 95% confidence interval 1.01 to 1.03, p = 0.025). In conclusion, our data show that patients with SVG lesions remain a high-risk subgroup with worse outcomes after percutaneous coronary intervention compared with native vessel disease even in the era of drug-eluting stents.

Original languageEnglish (US)
Pages (from-to)63-68
Number of pages6
JournalAmerican Journal of Cardiology
Volume101
Issue number1
DOIs
StatePublished - Jan 1 2008
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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