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

Published:November 16, 2007DOI:https://doi.org/10.1016/j.amjcard.2007.07.048
      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.
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      References

        • Bourassa M.G.
        • Fisher L.D.
        • Campeau L.
        • Gillespie M.J.
        • McConney M.
        • Lesperance J.
        Long-term fate of bypass grafts: the Coronary Artery Surgery Study (CASS) and Montreal Heart Institute experiences.
        Circulation. 1985; 72: V71-V78
        • Shaia N.
        • Heuser R.R.
        Distal embolic protection for SVG interventions: can we afford not to use it?.
        J Interv Cardiol. 2005; 18: 481-484
        • Silva J.A.
        • White C.J.
        Percutaneous intervention of old degenerated saphenous vein grafts.
        Int J Cardiovasc Intervent. 2001; 4: 187-194
        • Watson P.S.
        • Hadjipetrou P.
        • Cox S.V.
        • Pyne C.T.
        • Gossman D.E.
        • Piemonte T.C.
        • Eisenhauer A.C.
        Angiographic and clinical outcomes following acute infarct angioplasty on saphenous vein grafts.
        Am J Cardiol. 1999; 83: 1018-1021
        • Hanekamp C.E.
        • Koolen J.J.
        • Den Heijer P.
        • Schalij M.J.
        • Piek J.J.
        • Bar F.W.
        • De Scheerder I.
        • Bonnier H.J.
        • Pijls N.H.
        Randomized study to compare balloon angioplasty and elective stent implantation in venous bypass grafts: the Venestent study.
        Catheter Cardiovasc Interv. 2003; 60: 452-457
        • Savage M.P.
        • Douglas Jr, J.S.
        • Fischman D.L.
        • Pepine C.J.
        • King III, S.B.
        • Werner J.A.
        • Bailey S.R.
        • Overlie P.A.
        • Fenton S.H.
        • Brinker J.A.
        • Leon M.B.
        • Goldberg S.
        Stent placement compared with balloon angioplasty for obstructed coronary bypass grafts.
        N Engl J Med. 1997; 337: 740-747
        • Mehran R.
        • Dangas G.
        • Abizaid A.S.
        • Mintz G.S.
        • Lansky A.J.
        • Satler L.F.
        • Pichard A.D.
        • Kent K.M.
        • Stone G.W.
        • Leon M.B.
        Angiographic patterns of in-stent restenosis: classification and implications for long-term outcome.
        Circulation. 1999; 100: 1872-1878
        • The Joint European Society of Cardiology/American College of Cardiology Committee
        Myocardial infarction redefined—a consensus document of the Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction.
        Eur Heart J. 2000; 21: 1502-1513
        • Vermeersch P.
        • Agostoni P.
        • Verheye S.
        • Van den Heuvel P.
        • Convens C.
        • Bruining N.
        • Van den Branden F.
        • Van Langenhove G.
        Randomized double-blind comparison of sirolimus-eluting stent versus bare-metal stent implantation in diseased saphenous vein grafts: six-month angiographic, intravascular ultrasound, and clinical follow-up of the RRISC Trial.
        J Am Coll Cardiol. 2006; 48: 2423-2431
        • Wong S.C.
        • Baim D.S.
        • Schatz R.A.
        • Teirstein P.S.
        • King III, S.B.
        • Curry Jr, R.C.
        • Heuser R.R.
        • Ellis S.G.
        • Cleman M.W.
        • Overlie P.
        • et al.
        Immediate results and late outcomes after stent implantation in saphenous vein graft lesions: the multicenter U.S. Palmaz-Schatz stent experience.
        J Am Coll Cardiol. 1995; 26: 704-712
        • Fenton S.H.
        • Fischman D.L.
        • Savage M.P.
        • Schatz R.A.
        • Leon M.B.
        • Baim D.S.
        • King S.B.
        • Heuser R.R.
        • Curry Jr, R.C.
        • Rake R.C.
        • et al.
        Long-term angiographic and clinical outcome after implantation of balloon-expandable stents in aortocoronary saphenous vein grafts.
        Am J Cardiol. 1994; 74: 1187-1191
        • Ahmed J.M.
        • Dangas G.
        • Lansky A.J.
        • Mehran R.
        • Hong M.K.
        • Mintz G.S.
        • Pichard A.D.
        • Satler L.F.
        • Kent K.M.
        • Stone G.W.
        • Leon M.B.
        Influence of gender on early and one-year clinical outcomes after saphenous vein graft stenting.
        Am J Cardiol. 2001; 87: 401-405
        • Brener S.J.
        • Ellis S.G.
        • Apperson-Hansen C.
        • Leon M.B.
        • Topol E.J.
        Comparison of stenting and balloon angioplasty for narrowings in aortocoronary saphenous vein conduits in place for more than five years.
        Am J Cardiol. 1997; 79: 13-18
        • Stankovic G.
        • Colombo A.
        • Presbitero P.
        • van den Branden F.
        • Inglese L.
        • Cernigliaro C.
        • Niccoli L.
        • Bartorelli A.L.
        • Rubartelli P.
        • Reifart N.
        • et al.
        Randomized evaluation of polytetrafluoroethylene-covered stent in saphenous vein grafts: the Randomized Evaluation of polytetrafluoroethylene COVERed stent in Saphenous vein grafts (RECOVERS) Trial.
        Circulation. 2003; 108: 37-42
        • Turco M.A.
        • Buchbinder M.
        • Popma J.J.
        • Weissman N.J.
        • Mann T.
        • Doucet S.
        • Johnson Jr, W.L.
        • Greenberg J.D.
        • Leadley K.
        • Russell M.E.
        Pivotal, randomized U.S. study of the Symbiot trade mark covered stent system in patients with saphenous vein graft disease: eight-month angiographic and clinical results from the Symbiot III trial.
        Catheter Cardiovasc Interv. 2006; 68: 379-388
        • Stone G.W.
        • Goldberg S.
        • Mehran R.
        • O’Shaughnessy C.
        • Midei M.
        • Siegel R.
        • George B.
        • Salter S.
        • Rainzer A.
        • Negoita M.
        • et al.
        A prospective, randomized U.S. trial of the PTFE-covered JOSTENT for the treatment of diseased saphenous vein grafts: the BARRICADE trial.
        J Am Coll Cardiol. 2005; 45: 27A
        • Chu W.W.
        • Kuchulakanti P.K.
        • Wang B.
        • Clavijo L.C.
        • Suddath W.O.
        • Pichard A.D.
        • Satler L.F.
        • Kent K.M.
        • Waksman R.
        Efficacy of sirolimus-eluting stents as compared to paclitaxel-eluting stents for saphenous vein graft intervention.
        J Interv Cardiol. 2006; 19: 121-125
        • Tsuchida K.
        • Ong A.T.
        • Aoki J.
        • van Mieghem C.A.
        • Rodriguez-Granillo G.A.
        • Valgimigli M.
        • Sianos G.
        • Regar E.
        • McFadden E.P.
        • van der Giessen W.J.
        • et al.
        Immediate and one-year outcome of percutaneous intervention of saphenous vein graft disease with paclitaxel-eluting stents.
        Am J Cardiol. 2005; 96: 395-398
        • Lee M.S.
        • Shah A.P.
        • Aragon J.
        • Jamali A.
        • Dohad S.
        • Kar S.
        • Makkar R.R.
        Drug-eluting stenting is superior to bare metal stenting in saphenous vein grafts.
        Catheter Cardiovasc Interv. 2005; 66: 507-511
        • Ge L.
        • Iakovou I.
        • Sangiorgi G.M.
        • Chieffo A.
        • Melzi G.
        • Cosgrave J.
        • Montorfano M.
        • Michev I.
        • Airoldi F.
        • Carlino M.
        • Corvaja N.
        • Colombo A.
        Treatment of saphenous vein graft lesions with drug-eluting stents: immediate and midterm outcome.
        J Am Coll Cardiol. 2005; 45: 989-994
        • Waksman R.
        • Weintraub W.S.
        • Ghazzal Z.
        • Scott N.A.
        • Shen Y.
        • King III, S.B.
        • Douglas Jr, J.S.
        Short- and long-term outcome of narrowed saphenous vein bypass graft: a comparison of Palmaz-Schatz stent, directional coronary atherectomy, and balloon angioplasty.
        Am Heart J. 1997; 134: 274-281
        • Ashfaq S.
        • Ghazzal Z.
        • Douglas J.S.
        • Morris D.C.
        • Veledar E.
        • Weintraub W.S.
        Impact of diabetes on five-year outcomes after vein graft interventions performed prior to the drug-eluting stent era.
        J Invasive Cardiol. 2006; 18: 100-105
        • CASS Investigators
        Myocardial infarction and mortality in the Coronary Artery Surgery Study (CASS) randomized trial.
        N Engl J Med. 1984; 310: 750-758