title: Comparison of clinical outcomes in patients presenting with an acute coronary syndrome due to stent thrombosis or saphenous vein graft occlusion and undergoing percutaneous coronary intervention.
abstract: OBJECTIVE
  To compare the clinical outcomes of patients undergoing percutaneous intervention for stent thrombosis (ST) or saphenous vein graft (SVG) occlusion.
  
  
  BACKGROUND
  Patients presenting with ST or SVG occlusion are at increased risk of adverse outcomes. There is limited literature comparing the outcome of such patients.
  
  
  METHODS
  A cohort of 415 consecutive patients presenting to the MedStar Washington Hospital Center undergoing percutaneous coronary intervention (PCI) for an acute coronary syndrome secondary to ST (n=136) or SVG occlusion (n=279) was studied. The SVG group was subdivided into patients who underwent PCI in the occluded SVG (SVG-PCI: n=75) or in the subtended native coronary artery (NC-PCI: n=204). The analyzed clinical parameters were in-hospital complications as well as 30-day and 1-year major adverse cardiac events (MACE). MACE was defined as all-cause mortality, Q-wave myocardial infarction, or target vessel revascularization.
  
  
  RESULTS
  The rates of death, major bleeding, and length of hospital stay were significantly different between the ST and NC-PCI groups. The SVG-PCI group had a shorter hospital stay. The 30-day MACE rate was significantly different in the ST and NC-PCI groups (18.9% vs. 7.5%; risk ratio=0.40, 95% CI=0.20-0.81, p=0.03) but not in the ST and SVG-PCI groups (18.9% vs. 15.1%; p=0.55, risk ratio=0.80, 95% CI=0.38-1.68). There were no differences in the 1-year MACE rate.
  
  
  CONCLUSIONS
  As compared to patients undergoing NC-PCI, patients with ST have greater rates of in-hospital mortality and major bleeding as well as 30-day MACE rate. The 1-year MACE rate is similar in patients with ST and SVG occlusion who undergo PCI.
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Ota
authors.affiliation: University of Surrey, Guildford, Surrey, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Mahmoudi
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Thibault
authors.initials: T
authors.lastname: Lhermusier
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Magalhaes
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: William O
authors.initials: WO
authors.lastname: Suddath
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.affiliation: Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC. Electronic address: ron.waksman@medstar.net.
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D000046:Academic Medical Centers; D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002423:Cause of Death; D016009:Chi-Square Distribution; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D023903:Coronary Restenosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D004219:District of Columbia; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods* / Q000401:mortality; D011379:Prognosis; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D012501:Saphenous Vein / Q000637:transplantation; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Acute coronary syndrome; Percutaneous coronary intervention; SVG occlusion; Stent thrombosis