Predictors of outcome of percutaneous excimer laser coronary angioplasty of saphenous vein bypass graft lesions. The Percutaneous Excimer Laser Coronary Angioplasty Registry.
A total of 495 patients underwent treatment with excimer laser angioplasty for 545 saphenous vein graft stenoses. Clinical success was achieved in 455 of 495 patients (92%), as indicated by < or = 50% residual stenosis at every target lesion and no complication during hospitalization. At least 1 in-hospital complication occurred in 30 of 495 patients (6.1%): death (1.0%), bypass surgery (0.6%), and Q-wave (2.4%) or non-Q-wave (2.2%) myocardial infarction. Relative risk analysis showed that ostial lesions (n = 65) tended to have higher clinical success (success rate = 95%, adjusted odds ratio [OR] = 2.1 [95% confidence interval (CI) 0.62, 6.88]; p = 0.24) and lower complications (complication rate = 0%, OR = 0.10 [CI 0.01, 0.79]; p = 0.03) than lesions in the body of the vein graft. Lesions > 10 mm (n = 131) had lower success (success rate = 84%, OR = 0.30 [CI 0.16, 0.56]; p = 0.001) and higher complications (complication rate = 12%, OR = 3.3 [CI 1.6, 6.6]; p = 0.004) than discrete lesions. Lesions in small vein grafts < 3.0 mm (n = 76) tended to have increased success (success rate = 94%, OR = 1.55 [CI 0.70, 3.44]; p = 0.39) and lower complications (complication rate = 2.2%, OR = 0.31 [CI 0.10, 0.94]; p = 0.03). Thus, excimer laser-facilitated angioplasty has the most favorable outcome for discrete lesions located at the ostium of all grafts and in the body of smaller saphenous vein grafts.(ABSTRACT TRUNCATED AT 250 WORDS)
Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115.
J A
JA
Bittl
T A
TA
Sanborn
D E
DE
Yardley
J E
JE
Tcheng
J M
JM
Isner
S K
SK
Chokshi
B H
BH
Strauss
G S
GS
Abela
P D
PD
Walter
M
M
Schmidhofer
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017222:Angioplasty, Balloon, Laser-Assisted / Q000009:adverse effects / Q000379:methods; D017225:Atherectomy, Coronary; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000473:pathology / Q000601:surgery*; D004617:Embolism / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006083:Graft Occlusion, Vascular / Q000473:pathology / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D012008:Recurrence; D012501:Saphenous Vein / Q000473:pathology / Q000601:surgery / Q000637:transplantation*; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome; D014456:Ulcer / Q000473:pathology / Q000601:surgery