title: Impact of lesion location on intravascular ultrasound findings and short-term and five-year long-term clinical outcome after percutaneous coronary intervention for saphenous vein graft lesions.
abstract: BACKGROUND
  Little is known about intravascular ultrasound (IVUS) findings and acute post-percutaneous coronary intervention (PCI) outcome and long-term clinical outcome between aorto-ostial lesion and shaft lesion after PCI for saphenous vein graft (SVG) lesions.
  
  
  METHODS
  Aorto-ostial lesion was defined as those arising within 3mm of the origin of SVG and shaft lesion was defined as those arising in remaining portion of SVG. We evaluated pre- and post-PCI IVUS images of 311 SVG lesions and compared IVUS findings and acute post-PCI outcome and 5-year clinical outcome between aorto-ostial lesion (n=64) and shaft lesion (n=247).
  
  
  RESULTS
  The presence of positive remodeling (40% vs. 22%, p=0.026), hypoechoic plaque (47% vs. 36%, p=0.035), plaque rupture (23% vs. 8%, p=0.008), multiple plaque rupture (9% vs. 2%, p=0.038), and an intraluminal mass (54% vs. 25%, p<0.001) were significantly more common in shaft lesion than in aorto-ostial lesion. Post-PCI no-reflow (15% vs. 5%, p=0.033), post-PCI tissue prolapse (TP) (40% vs. 23%, p=0.014), and post-PCI creatine kinase-MB elevation more than 3 times normal (14% vs. 8%, p=0.047) were observed more frequently after PCI for shaft lesion than for aorto-ostial lesion. At 5-year clinical follow-up, the incidences of death (25% vs. 13%, p=0.036) and myocardial infarction (24% vs. 11%, p=0.028), but not the rate of target vessel revascularization (36% vs. 25%, p=0.096), were significantly higher in patients with shaft lesion compared with those with aorto-ostial lesion.
  
  
  CONCLUSIONS
  SVG shaft lesion has more unstable plaque morphology and this may contribute to the worse acute PCI outcomes and long-term outcomes.
authors.affiliation: Heart Center of Chonnam National University Hospital, South Korea.
authors.forename: Young Joon
authors.initials: YJ
authors.lastname: Hong
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.forename: Youngkeun
authors.initials: Y
authors.lastname: Ahn
authors.forename: Jung Chaee
authors.initials: JC
authors.lastname: Kang
authors.forename: Gary S
authors.initials: GS
authors.lastname: Mintz
authors.forename: Sang Wook
authors.initials: SW
authors.lastname: Kim
authors.forename: Sung Yun
authors.initials: SY
authors.lastname: Lee
authors.forename: Seok Yeon
authors.initials: SY
authors.lastname: Kim
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Weissman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods / Q000639:trends*; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000000981:diagnostic imaging* / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods / Q000639:trends*