Effect of direct stenting on clinical outcome in patients treated with percutaneous coronary intervention on saphenous vein graft.
BACKGROUND
Percutaneous coronary intervention (PCI) of saphenous vein graft (SVG) is associated with frequent postprocedural enzyme elevation and late cardiac events. New strategies are proposed to minimize distal embolization and to improve the outcome of patients treated with stenting for SVG lesions. The objectives of the current study were to examine direct stenting (DS) strategy of PCI in SVG lesions and its effects on creatine-kinase (CK) release, major adverse cardiac events (MACE), and late outcome when compared to conventional stenting (CS).


METHODS
A consecutive series of 527 patients treated with stent implantation for SVG stenosis was analyzed. In this cohort, 170 patients with 229 lesions were treated with DS and 357 patients with 443 lesions were treated with CS. The inhospital and 12-month follow-up events were recorded and reported.


RESULTS
Baseline clinical and postprocedural angiographic characteristics were similar between the 2 groups except for higher preprocedural prevalence of thrombus-containing lesions in the DS group. Patients in the DS group had less CK-MB release (P <.001), and less non-Q-wave myocardial infarction (P =.024). Multivariate analysis detected unstable angina (odds ratio [OR] = 1.8, P =.03) as a correlate for non-Q-wave MI; DS was inversely associated with non-Q-wave myocardial infarction (OR = 0.65, P =.04). At 1 year, the target lesion revascularization-MACE was significantly lower in the DS group (P =.021). Multivariate analysis showed that DS (OR = 0.47, P =.007) was associated with reduction of the target lesion revascularization-MACE.


CONCLUSIONS
When feasible, DS may be the best approach for treating SVG stenosis.
Leborgne
Laurent
L
Cardiovascular Research Institute, Division of Cardiology, Washington Hospital Center, Washington, DC 20100, USA.
Cheneau
Edouard
E
Pichard
Augusto
A
Ajani
Andrew
A
Pakala
Rajbabu
R
Yazdi
Hamid
H
Satler
Lowell
L
Kent
Kenneth
K
Suddath
William O
WO
Pinnow
Ellen
E
Canos
Daniel
D
Waksman
Ron
R
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods*; D001161:Arteriosclerosis / Q000150:complications*; D015415:Biomarkers / Q000097:blood; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D003327:Coronary Disease / Q000201:enzymology / Q000601:surgery / Q000628:therapy*; D003402:Creatine Kinase / Q000097:blood*; D052279:Creatine Kinase, MB Form; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000201:enzymology / Q000517:prevention & control*; D006801:Humans; D007527:Isoenzymes / Q000097:blood*; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000637:transplantation*; D018709:Statistics, Nonparametric; D015607:Stents; D016896:Treatment Outcome; D014654:Vascular Patency
D015415:Biomarkers; D007527:Isoenzymes; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form