Elsevier

American Heart Journal

Volume 146, Issue 3, September 2003, Pages 501-506
American Heart Journal

Interventional cardiology
Effect of direct stenting on clinical outcome in patients treated with percutaneous coronary intervention on saphenous vein graft

https://doi.org/10.1016/S0002-8703(03)00309-0Get rights and content

Abstract

Background

Percutaneous coronary intervention (PCI) of saphenous vein graft (SVG) is associated with frequent postprocedural enzyme elevation and late cardiac events. New strategies are proposed to minimize distal embolization and to improve the outcome of patients treated with stenting for SVG lesions. The objectives of the current study were to examine direct stenting (DS) strategy of PCI in SVG lesions and its effects on creatine-kinase (CK) release, major adverse cardiac events (MACE), and late outcome when compared to conventional stenting (CS).

Methods

A consecutive series of 527 patients treated with stent implantation for SVG stenosis was analyzed. In this cohort, 170 patients with 229 lesions were treated with DS and 357 patients with 443 lesions were treated with CS. The inhospital and 12-month follow-up events were recorded and reported.

Results

Baseline clinical and postprocedural angiographic characteristics were similar between the 2 groups except for higher preprocedural prevalence of thrombus-containing lesions in the DS group. Patients in the DS group had less CK-MB release (P < .001), and less non-Q–wave myocardial infarction (P = .024). Multivariate analysis detected unstable angina (odds ratio [OR] = 1.8, P = .03) as a correlate for non-Q–wave MI; DS was inversely associated with non-Q–wave myocardial infarction (OR = 0.65, P = .04). At 1 year, the target lesion revascularization-MACE was significantly lower in the DS group (P = .021). Multivariate analysis showed that DS (OR = 0.47, P = .007) was associated with reduction of the target lesion revascularization-MACE.

Conclusions

When feasible, DS may be the best approach for treating SVG stenosis.

Section snippets

Study population

Between January 1994 and May 2001, 1650 consecutive patients with prior coronary artery bypass surgery underwent percutaneous angioplasty for narrowing SVG lesions at the Washington Hospital Center. Patients with total occlusion, acute MI, or restenosis were excluded. In this cohort, we identified 170 patients with 229 lesions that were treated with DS and 357 patients with 443 lesions that were treated with CS (without debulking before stenting). The entire patient cohort was treated without

Baseline demographics

The clinical characteristics of the patients are displayed in Table I. The patient group represents a typical patient cohort undergoing SVG stenting, with a high prevalence of unstable angina (74.4%). The average graft age was 8.77 ± 4.8 years. There was a high prevalence of diabetes (34.4%) and insulin-dependent diabetes was present in 14.4% of the patients. Patient demographic data were similar between the 2 groups except for a trend for more hypertension in the DS patients (73.5% vs 66.4%, P

Discussion

Our study shows that PCI with DS of SVG lesions is associated with a high clinical success rate and significantly decreases both the rates of high CK-elevation postangioplasty and the major cardiac events at 1-year follow-up when compared to PCI with predilatation.

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