Long-term angiographic and clinical outcome after implantation of balloon-expandable stents in aortocoronary saphenous vein grafts.
Balloon angioplasty of aortocoronary saphenous vein graft lesions is associated with high restenosis and clinical event rates. The goal of this multicenter study was to assess long-term angiographic and clinical outcome of patients electively treated with single Palmaz-Schatz stents in aortocoronary saphenous vein grafts. In 198 patients (209 lesions), elective placement of single Palmaz-Schatz stents was attempted. Angiography was performed at baseline, immediately after stent placement, and at 6-month follow-up. Stent placement was successful in 98.5% of patients. One patient (0.5%) had stent thrombosis. Restenosis occurred in 34% (45 of 133) of the restudied lesions. Restenosis was lower in de novo lesions than in restenotic lesions (22% vs 51%, p < 0.001). Ostial lesions had a higher restenosis rate than nonostial lesions (61% vs 28%, p = 0.003). Freedom from death, myocardial infarction, coronary artery bypass surgery, and repeat angioplasty was present in 70% of patients. Eighty-two percent of patients with de novo lesions remained event-free at 1 year, whereas only 55% of patients with prior angioplasty were event-free at 1 year (p < 0.001). The use of the Palmaz-Schatz stent for the treatment of focal, de novo, aortocoronary saphenous vein graft lesions is associated with a high procedural success rate, a low angiographic restenosis rate, and low clinical event rates, including the need for repeat revascularization. The results of this study need validation by a prospective randomized trial comparing stent implantation with angioplasty.
Fenton
S H
SH
Jefferson Medical College, Division of Cardiology, Philadelphia, Pennsylvania 19107.
Fischman
D L
DL
Savage
M P
MP
Schatz
R A
RA
Leon
M B
MB
Baim
D S
DS
King
S B
SB
Heuser
R R
RR
Curry
R C
RC
Rake
R C
RC
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000601:surgery / Q000628:therapy*; D018572:Disease-Free Survival; D005260:Female; D006083:Graft Occlusion, Vascular / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012501:Saphenous Vein / Q000637:transplantation; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome