title: Short- and long-term outcomes after stent-assisted percutaneous treatment of saphenous vein grafts in the drug-eluting stent era.
abstract: 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.
authors.affiliation: Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY, USA.
authors.forename: Tereza
authors.initials: T
authors.lastname: Pucelikova
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: Ajay J
authors.initials: AJ
authors.lastname: Kirtane
authors.forename: Young-Hak
authors.initials: YH
authors.lastname: Kim
authors.forename: Martin
authors.initials: M
authors.lastname: Fahy
authors.forename: Giora
authors.initials: G
authors.lastname: Weisz
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Lansky
authors.forename: Issam
authors.initials: I
authors.lastname: Moussa
authors.forename: William A
authors.initials: WA
authors.lastname: Gray
authors.forename: Michael B
authors.initials: MB
authors.lastname: Collins
authors.forename: Susheel K
authors.initials: SK
authors.lastname: Kodali
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.forename: George
authors.initials: G
authors.lastname: Dangas
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology; D009206:Myocardium / Q000473:pathology; D009336:Necrosis; D017239:Paclitaxel / Q000008:administration & dosage; D011446:Prospective Studies; D011474:Prosthesis Design; D012042:Registries; D019233:Retreatment; D012501:Saphenous Vein / Q000637:transplantation*; D020123:Sirolimus / Q000008:administration & dosage; D015607:Stents; D013927:Thrombosis / Q000401:mortality / Q000628:therapy*
chemical_list: D017239:Paclitaxel; D020123:Sirolimus