Follow-up results after interventional treatment of infarct-related saphenous vein graft occlusion

Coron Artery Dis. 2010 Mar;21(2):61-4. doi: 10.1097/MCA.0b013e328332ee4b.

Abstract

Background: Acute occlusion of saphenous vein grafts resulting in acute coronary syndromes may be treated with interventional revascularization. Few data are available on intermediate and long-term results after revascularization of acute saphenous vein graft occlusion.

Methods: Fifty patients (67+/-10 years, 47 male) with troponin-positive acute coronary syndrome because of acute total or subtotal occlusion [thrombolysis in myocardial infarction (TIMI) flow 0=39, TIMI 1=8, TIMI 2=3] of one saphenous vein graft (12.0+/-5.3 years after surgery, 3.6+/-0.9 grafts) were treated with percutaneous coronary intervention (39 patients using bare-metal stents, 11 patients using drug-eluting stents). Clinical follow-up was obtained in all patients. Angiographic 6-month follow-up was performed in 35 patients (70%).

Results: Acute revascularization of the infarct-related saphenous vein graft (lesion length 17.6+/-10.3 mm, reference diameter 3.1+/-0.8 mm) was possible in 94% of patients. After a mean follow-up of 32.5+/-17.4 months, 13 patients (26%) died, 13 patients (26%) had recurrent myocardial infarction, and 20 patients (40%) had recurrent coronary revascularization (percutaneous coronary intervention or coronary artery bypass grafting). Angiographic follow-up showed reocclusion of the vein graft in three cases (9%). Twenty-one percent of lesions were found to be restenotic.

Conclusion: Acute revascularization of an infarct-related saphenous vein graft is possible in the majority of cases. Angiographic follow-up data show a high patency rate at 6-month follow-up. Still, the clinical prognosis of patients with revascularized infarct-related saphenous vein graft is quite poor.

MeSH terms

  • Acute Coronary Syndrome / diagnostic imaging
  • Acute Coronary Syndrome / etiology
  • Acute Coronary Syndrome / mortality
  • Acute Coronary Syndrome / physiopathology
  • Acute Coronary Syndrome / therapy*
  • Aged
  • Angioplasty, Balloon, Coronary* / adverse effects
  • Angioplasty, Balloon, Coronary* / instrumentation
  • Angioplasty, Balloon, Coronary* / mortality
  • Chi-Square Distribution
  • Coronary Angiography
  • Coronary Artery Bypass / adverse effects*
  • Coronary Circulation
  • Drug-Eluting Stents
  • Female
  • Follow-Up Studies
  • Graft Occlusion, Vascular / diagnostic imaging
  • Graft Occlusion, Vascular / etiology
  • Graft Occlusion, Vascular / mortality
  • Graft Occlusion, Vascular / physiopathology
  • Graft Occlusion, Vascular / therapy*
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Metals
  • Middle Aged
  • Myocardial Infarction / diagnostic imaging
  • Myocardial Infarction / etiology
  • Myocardial Infarction / mortality
  • Myocardial Infarction / physiopathology
  • Myocardial Infarction / therapy*
  • Prosthesis Design
  • Recurrence
  • Saphenous Vein / transplantation*
  • Stents
  • Time Factors
  • Treatment Outcome
  • Vascular Patency

Substances

  • Metals