title: Long-term follow-up of a high risk cohort after stent implantation in saphenous vein grafts.
abstract: OBJECTIVE
  We sought to provide short- and long-term clinical outcomes of a high risk cohort treated with stents in saphenous vein grafts (SVGs).
  
  
  BACKGROUND
  Data on the long-term outcome of SVG stenting in high risk patients are limited.
  
  
  METHODS
  Johnson & Johnson stents were implanted in the SVGs of 186 patients (302 stents, 244 lesions). Ninety percent of patients presented with myocardial infarction (MI) or unstable angina (mean +/- SD ejection fraction [EF] 44 +/- 11%, patient age 71 +/- 9 years, graft age 9.4 +/- 5 years). Using a risk score classification, 155 patients (83%) were defined as high risk for repeat surgical repair or angioplasty.
  
  
  RESULTS
  The procedural success rate was 97.3%, with 2.7% major complications (death, Q wave MI, coronary artery bypass graft surgery [CABG]). Clinical follow-up was obtained in 177 patients (mean 19.1 +/- 13.5 months, range 7 to 59). Event rates were 10% for death; 9% for MI; 11% for repeat CABG; and 15% for repeat angioplasty (total events 45%). Kaplan-Meier estimated survival and event-free survival at 4 years were 0.79 +/- 0.06 and 0.29 +/- 0.07, respectively. Predictors of death were congestive heart failure (p < 0.01) and EF <44% (p < 0.05). Predictors of combined events of death, MI and CABG were low EF (p < 0.01) and high SVG age (>10 years, p < 0.01). There were 66 revascularization procedures (35% of patients), 24% of which were in nontarget lesions. Fifty-three percent of the cardiac events occurred during the first year of follow-up. Of the 160 survivors, 36% were free of angina, 49% were in Canadian Cardiovascular Society functional class I or II, and 15% were in class III or IV. Sixty-nine percent of patients were in class I or II according to the Specific Activity Scale, and 31% of patients were in class III or IV.
  
  
  CONCLUSIONS
  Balloon-expandable stent implantation in the SVGs of high risk patients is associated with a low early complication rate. Expected survival rates are good, as are the anginal and functional classifications, but there is a high rate of recurrent events and need for repeat revascularization. Vein graft stenting is an acceptable palliative option in many high risk patients.
authors.affiliation: Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
authors.forename: A
authors.initials: A
authors.lastname: Frimerman
authors.forename: E
authors.initials: E
authors.lastname: Rechavia
authors.forename: N
authors.initials: N
authors.lastname: Eigler
authors.forename: M R
authors.initials: MR
authors.lastname: Payton
authors.forename: R
authors.initials: R
authors.lastname: Makkar
authors.forename: F
authors.initials: F
authors.lastname: Litvack
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003251:Constriction, Pathologic; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000637:transplantation*; D015607:Stents; D016019:Survival Analysis