Short- and Long-Term Outcomes After Stent-Assisted Percutaneous Treatment of Saphenous Vein Grafts in the Drug-Eluting Stent Era - 09/08/11
, Ajay J. Kirtane, MD, SM, Young-Hak Kim, MD, Martin Fahy, MSc, Giora Weisz, MD, Alexandra J. Lansky, MD, Issam Moussa, MD, William A. Gray, MD, Michael B. Collins, MD, Susheel K. Kodali, MD, Gregg W. Stone, MD, Jeffrey W. Moses, MD, Martin B. Leon, MD, George Dangas, MD, PhD
Corresponding author: Tel: 212-851-9340; fax: 212-223-4109.Résumé |
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.
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Vol 101 - N° 1
P. 63-68 - janvier 2008 Retour au numéro
Article précédent
- Clinical Outcomes After Heterogeneous Overlap Stenting With Drug-Eluting Stents and Bare-Metal Stents for de Novo Coronary Artery Narrowings
- Jiro Aoki, Ajay J. Kirtane, George D. Dangas, Alexandra J. Lansky, Andy Morales, Masashi Kimura, Young-Hak Kim, Issam Moussa, Giora Weisz, Edward M. Kreps, Michael Collins, Theresa Frankin-Bond, Gregg W. Stone, Jeffrey W. Moses, Martin B. Leon, Roxana Mehran
- A Geospatial Analysis of Emergency Transport and Inter-Hospital Transfer in ST-Segment Elevation Myocardial Infarction
- Thomas W. Concannon, David M. Kent, Sharon-Lise Normand, Joseph P. Newhouse, John L. Griffith, Robin Ruthazer, Joni R. Beshansky, John B. Wong, Thomas Aversano, Harry P. Selker
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