title: Comparison of procedural success and long-term outcomes of stent thrombosis in coronary bypass grafts versus native coronary arteries.
abstract: Percutaneous coronary intervention within bypass grafts accounts for a significant percentage of total interventions. Bypass graft interventions are associated with an increased risk for stent thrombosis (ST), a condition that leads to significant morbidity and mortality. Despite this, the procedural characteristics and long-term outcomes of patients with bypass-graft ST have not been reported. The aim of the present study was to evaluate the procedural success and long-term outcomes of patients presenting with ST of coronary bypass grafts. Clinical and procedural characteristics of 205 ST cases at 5 academic hospitals were reviewed. Long-term mortality and major adverse cardiovascular events (stroke, reinfarction, and revascularization) were ascertained through review of medical records and the Social Security Death Index. Kaplan-Meier analysis was used to determine the association between ST in a bypass graft and long-term outcomes. Thirteen patients (6%) in the cohort presented with ST of a coronary bypass graft. Patients with bypass-graft ST had less severe presentations with a lower proportion of ST-segment elevation myocardial infarction (23% vs 69%, p <0.001). Despite this, ST of a bypass graft was associated with a trend toward reduced postprocedural Thrombolysis In Myocardial Infarction (TIMI) flow grade (p = 0.09), leading to lower angiographic (58% vs 92%, p <0.001) and procedural (62% vs 92%, p <0.001) success. After multivariate adjustment, bypass-graft ST was associated with increased long-term mortality (hazard ratio 3.3, 95% confidence interval 1.0 to 10.7) and major adverse cardiovascular events (hazard ratio 2.7, 95% confidence interval 1.1 to 6.9). In conclusion, ST in coronary bypass grafts is associated with reduced angiographic and procedural success as well as increased long-term major adverse cardiovascular events compared to ST in native coronary vessels.
authors.affiliation: Department of Medicine, Division of Cardiology, University of California, San Francisco, San Francisco, CA, USA. stephen.waldo@ucsf.edu
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Waldo
authors.forename: Ehrin J
authors.initials: EJ
authors.lastname: Armstrong
authors.forename: Khung Keong
authors.initials: KK
authors.lastname: Yeo
authors.forename: Ehtisham
authors.initials: E
authors.lastname: Mahmud
authors.forename: Mitul
authors.initials: M
authors.lastname: Patel
authors.forename: Ryan
authors.initials: R
authors.lastname: Reeves
authors.forename: John S
authors.initials: JS
authors.lastname: MacGregor
authors.forename: Reginald I
authors.initials: RI
authors.lastname: Low
authors.forename: Jason H
authors.initials: JH
authors.lastname: Rogers
authors.forename: Kendrick A
authors.initials: KA
authors.lastname: Shunk
mesh_terms: D000368:Aged; D002140:California / Q000453:epidemiology; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000601:surgery*; D011446:Prospective Studies; D011475:Prosthesis Failure; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome