1
|
Coronary Angiography Characteristics of Symptomatic Patients with Prior Coronary Artery Bypass Graft: A Descriptive Study. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1832128. [PMID: 31815124 PMCID: PMC6877980 DOI: 10.1155/2019/1832128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 09/11/2019] [Accepted: 09/21/2019] [Indexed: 11/25/2022]
Abstract
Objectives The target of this study was to explore the coronary angiography characteristics for symptomatic patients with prior coronary artery bypass graft (CABG). Methods Between 2009 and 2017, 993 patients who had undergone CABG but subsequently suffered recurrent symptoms in Beijing Anzhen Hospital were selected for this study and divided into either medical therapy (MT) group (n = 351) or percutaneous coronary intervention (PCI) group (n = 642) based on the treatment. Clinical data were analyzed between two groups. Results Patients in the MT group were older and more likely to have chronic lung disease (6.6% vs 3.4%, P=0.026) while patients in the PCI group were more likely to have prior MI (8.8% vs 17.0%, P < 0.001). In the MT group, 54.4% of patients had newly developed lesions both in the graft and native coronary artery while 58.1% in the PCI group (P=0.003), and in the MT group, 80.6% had type C coronary artery disease while 60.1% in the PCI group (P < 0.001). Patients in the MT group presented higher proportion of diffuse lesions (49.3% vs 15.0%, P < 0.001) in native coronary arteries. Conclusion Patients receiving MT (35.3%) likely had occluded grafts and type C coronary artery disease featuring as diffuse lesions.
Collapse
|
2
|
Scarsini R, Zivelonghi C, Pesarini G, Vassanelli C, Ribichini FL. Repeat revascularization: Percutaneous coronary intervention after coronary artery bypass graft surgery. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:272-8. [PMID: 27215852 DOI: 10.1016/j.carrev.2016.04.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 04/14/2016] [Accepted: 04/22/2016] [Indexed: 01/25/2023]
Abstract
Repeat myocardial revascularization procedures are markedly different from de novo interventions, with increased procedural risk and technical-demanding complexity. However the number of patients previously treated with coronary artery bypass graft (CABG) that need a repeat revascularization due to graft failure is increasing consistently. Late graft failure, usually caused by saphenous vein grafts (SVG) attrition, is certainly not uncommon. However PCI on degenerated SVG presents higher complication rate and worse clinical outcome compared with native arteries interventions. In acute graft failure setting, PCI represents a valuable option to treat postoperative myocardial infarction.
Collapse
Affiliation(s)
- Roberto Scarsini
- University of Verona, Department of Medicine, Section of Cardiology, Italy.
| | - Carlo Zivelonghi
- University of Verona, Department of Medicine, Section of Cardiology, Italy
| | - Gabriele Pesarini
- University of Verona, Department of Medicine, Section of Cardiology, Italy
| | - Corrado Vassanelli
- University of Verona, Department of Medicine, Section of Cardiology, Italy
| | - Flavio L Ribichini
- University of Verona, Department of Medicine, Section of Cardiology, Italy
| |
Collapse
|
3
|
Beohar N, Meyers SN, Erdogan A, Harinstein ME, Pieper K, Gagnon S, Davidson CJ. Off-label use of drug-eluting versus bare metal stents: a lesion-specific systematic review of long-term outcomes. J Interv Cardiol 2010; 23:528-45. [PMID: 20735712 DOI: 10.1111/j.1540-8183.2010.00588.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The purpose of this systematic review was to evaluate differences in lesion-specific outcomes with the "off-label" use of drug-eluting stents (DES) versus bare metal stents (BMS). METHODS MEDLINE, PubMed, the Cochrane databases, and other Web were searched for studies evaluating off-label use of DES and BMS with the same characteristics. Of 1,258 abstracts or manuscripts reviewed, 112 studies were included (total N = 23,438). Studies were excluded if patients received both types of stent or no stent; lesion type was unknown; lesion-specific outcomes for ≥6 months were unavailable; or <25 patients were enrolled. RESULTS Overall mortality at 6-12 months was approximately 3% for BMS and DES for off-label use. Increase in mortality was greater from 6-12 months to 2 years with BMS than with DES (3.3%-9.1%; 2.8%-4.1%); however, rates were similar at 3 years (BMS: 18.8%; DES:15.3%). Myocardial Infarction rates were similar for both types at 6-12 months (BMS: 6.5%; DES: 6.0%). Overall rates of stent thrombosis were 1.8% and 1.7% for BMS and DES, respectively. Similar or slightly lower rates of stent thrombosis were seen for most lesion types, except higher rates for small vessels for BMS (5.2%) and true bifurcation for DES (3.3%). Rates of target lesion revascularization (TLR) were 7.5% for BMS and 19.6% for DES at 6-12 months. At 2-years TLR remained lower than DES. When the combined group was compared to registry data alone, similar values were seen. CONCLUSIONS Rates of mortality, myocardial infarction (MI), and stent thrombosis were similar in patients receiving BMS or DES, while TLR rates were lower in DES patients.
Collapse
Affiliation(s)
- Nirat Beohar
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA.
| | | | | | | | | | | | | |
Collapse
|
4
|
Goswami NJ, Gaffigan M, Berrio G, Plessa AL, Pfeiffer AM, Markwell SJ, Mishkel GJ. Long-term outcomes of drug-eluting stents versus bare-metal stents in saphenous vein graft disease: results from the Prairie "Real World" Stent Registry. Catheter Cardiovasc Interv 2010; 75:93-100. [PMID: 19787803 DOI: 10.1002/ccd.22194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES This study was designed to compare long-term clinical outcomes of drug-eluting stents (DES) versus bare metal stents (BMS) in patients with saphenous vein graft (SVG) disease in the "real world." BACKGROUND The safety and efficacy of DES versus BMS in SVG remains uncertain due to contradictory reports of either lower revascularization rates with DES; or clinical equivalence to BMS; or even an excess of clinical events associated with DES use. METHODS We identified consecutive patients who underwent stent placement within a de novo SVG lesion between May 1, 2003 and July 31, 2007. Follow-up was obtained at regular intervals. The Kaplan-Meier method was used to produce actuarial survival estimates. Cox regression analysis was used to predict the risk associated with stent type, and propensity scores were generated to risk-adjust the results. RESULTS The study group included 379 stent recipients (284 DES; 95 BMS) with 410 stented lesions. BMS were placed more frequently in current smokers, acute myocardial infarctions, larger vessels, and longer lesions. In-hospital mortality was higher in BMS recipients than in their DES counterparts (3.2% vs. 0, respectively; P = 0.015). At 3 years, there was no significant difference in clinical adverse event rates between DES and BMS recipients, even after risk adjustment. CONCLUSIONS Three-year adverse event rates are similar among patients treated with DES or BMS in SVG lesions. Therefore, while DES are safe, they do not appear to offer an advantage in terms of long-term graft patency.
Collapse
Affiliation(s)
- Nilesh J Goswami
- Prairie Heart Institute at St. John's Hospital, Springfield, IL 62794-9420, USA.
| | | | | | | | | | | | | |
Collapse
|
5
|
Brilakis E, Saeed B, Banerjee S. Drug-eluting stents in saphenous vein graft interventions: a systematic review. EUROINTERVENTION 2010; 5:722-30. [DOI: 10.4244/eijv5i6a119] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
6
|
Kaplan S, Barlis P, Kaplan S, Barlis P, Kiris A, Dimopoulos K, Celik S, Di Mario C. Immediate procedural and long-term clinical outcomes following drug-eluting stent implantation to ostial saphenous vein graft lesions. ACTA ACUST UNITED AC 2009; 10:88-92. [DOI: 10.1080/17482940701885400] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
7
|
Lozano I, Avanzas P, Rondan J. Stent implantation in saphenous vein grafts. Am J Cardiol 2009; 103:1042-3. [PMID: 19327440 DOI: 10.1016/j.amjcard.2009.01.351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2009] [Accepted: 01/31/2009] [Indexed: 11/27/2022]
|
8
|
Lozano Í, García-Camarero T, Carrillo P, Baz JA, de la Torre JM, López-Palop R, Pinar E, Salvatella N, Avanzas P, Valdés M. Comparación de los stents liberadores de fármaco y los convencionales en puentes de safena. Resultados inmediatos y a largo plazo. Rev Esp Cardiol 2009. [DOI: 10.1016/s0300-8932(09)70019-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
9
|
Gioia G, Benassi A, Mohendra R, Chowdhury K, Masood I, Matthai W. Lack of clinical long-term benefit with the use of a drug eluting stent compared to use of a bare metal stent in saphenous vein grafts. Catheter Cardiovasc Interv 2008; 72:13-20. [DOI: 10.1002/ccd.21599] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
10
|
Assali A, Raz Y, Vaknin-Assa H, Ben-Dor I, Brosh D, Teplitsky I, Fuchs S, Kornowski R. Beneficial 2-years results of drug-eluting stents in saphenous vein graft lesions. EUROINTERVENTION 2008; 4:108-14. [DOI: 10.4244/eijv4i1a18] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
11
|
Mamas M, Fraser D, Fath-Ordoubadi F. The role of thrombectomy and distal protection devices during percutaneous coronary interventions. EUROINTERVENTION 2008; 4:115-23. [DOI: 10.4244/eijv4i1a19] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
12
|
BRILAKIS EMMANOUILS, SAEED BILAL, BANERJEE SUBHASH. Use of Drug-Eluting Stents in Saphenous Vein Aortocoronary Bypass Graft Lesions: A Critical Appraisal. J Interv Cardiol 2008; 21:151-7. [DOI: 10.1111/j.1540-8183.2007.00341.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
|
13
|
|
14
|
Affiliation(s)
- Antonio Colombo
- San Raffaele Scientific Institute and EMO Centro Cuore Columbus, 20145 Milan, Italy.
| | | |
Collapse
|
15
|
Silber S, Borggrefe M, Böhm M, Hoffmeister H, Dietz R, Ertl G, Heusch G. Positionspapier der DGK zur Wirksamkeit und Sicherheit von Medikamente freisetzenden Koronarstents (DES). KARDIOLOGE 2007. [DOI: 10.1007/s12181-007-0012-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
16
|
Ruchin PE, Faddy SC, Muller DWM, Baron DW, Roy PR, Wilson SH. Clinical Follow-Up of Paclitaxel-Eluting (TAXUS?) Stents for the Treatment of Saphenous Vein Graft Disease. J Interv Cardiol 2007; 20:258-64. [PMID: 17680855 DOI: 10.1111/j.1540-8183.2007.00268.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Randomized trials in selected patient populations have demonstrated dramatic reductions in the incidence of in-stent restenosis (ISR) following implantation of paclitaxel-eluting (PE) coronary stents compared with bare metal stents in native coronary disease. The clinical outcome following implantation of PE stents for saphenous vein graft (SVG) stenosis is largely unknown. AIM To assess the safety and efficacy of PE coronary stents for the treatment of SVG stenosis in an unselected population. METHODS All patients who received PE stents for the treatment of SVG disease from May 1, 2003, to May 1, 2005, were entered into a prospectively collected database. Fifty-five patients were identified with 69 lesions. In-hospital and late major adverse cardiac events (MACE) including death, myocardial infarction (MI), and target lesion revascularization (TLR) were recorded as well as the rate of target vessel revascularization (TVR). RESULTS Mean follow-up was 13 months with 54 of the 55 patients contacted. The number of stents implanted was 1.12 +/- 0.37 per lesion and 1.38 +/- 0.59 per patient. Clinically significant procedural MACE was 0%. The late MACE rate was 9% with a 2% clinically driven TLR, a 4% coronary artery bypass graft (CABG), and a 4% TVR rate. There were four deaths, two cardiac and two noncardiac. CONCLUSION PE stents appear safe and effective in the treatment of SVG disease at a mean follow-up time of 13 months. Randomized studies are needed to further delineate the optimal management of this high-risk group.
Collapse
Affiliation(s)
- P E Ruchin
- Department of Cardiology, St. Vincent's Hospital, Darlinghurst, NSW, Australia
| | | | | | | | | | | |
Collapse
|
17
|
Ellis SG. “Crying Fire in a Theater” or a “Confirmatory Sighting?”⁎⁎Editorials published in the Journal of the American College of Cardiologyreflect the views of the authors and do not necessarily represent the views of JACCor the American College of Cardiology. J Am Coll Cardiol 2007; 50:268-9. [PMID: 17631220 DOI: 10.1016/j.jacc.2007.05.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2007] [Accepted: 05/15/2007] [Indexed: 11/18/2022]
|
18
|
Vermeersch P, Agostoni P, Verheye S, Van den Heuvel P, Convens C, Bruining N, Van den Branden F, Van Langenhove G. Randomized Double-Blind Comparison of Sirolimus-Eluting Stent Versus Bare-Metal Stent Implantation in Diseased Saphenous Vein Grafts. J Am Coll Cardiol 2006; 48:2423-31. [PMID: 17174178 DOI: 10.1016/j.jacc.2006.09.021] [Citation(s) in RCA: 207] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2006] [Revised: 07/17/2006] [Accepted: 07/18/2006] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We sought to compare, in a randomized fashion, sirolimus-eluting stents (SES) versus bare-metal stents (BMS) in saphenous vein grafts (SVGs). BACKGROUND Sirolimus-eluting stents reduce restenosis and repeated revascularization in native coronary arteries compared with BMS. However, randomized data in SVG are absent. METHODS Patients with SVG lesions were randomized to SES or BMS. All were scheduled to undergo 6-month coronary angiography. The primary end point was 6-month angiographic in-stent late lumen loss. Secondary end points included binary angiographic restenosis, neointimal volume by intravascular ultrasound and major adverse clinical events (death, myocardial infarction, target lesion, and vessel revascularization). RESULTS A total of 75 patients with 96 lesions localized in 80 diseased SVGs were included: 38 patients received 60 SES for 47 lesions, whereas 37 patients received 54 BMS for 49 lesions. In-stent late loss was significantly reduced in SES (0.38 +/- 0.51 mm vs. 0.79 +/- 0.66 mm in BMS, p = 0.001). Binary in-stent and in-segment restenosis were reduced, 11.3% versus 30.6% (relative risk [RR] 0.37; 95% confidence interval [CI] 0.15 to 0.97, p = 0.024) and 13.6% versus 32.6% (RR 0.42; 95% CI 0.18 to 0.97, p = 0.031), respectively. Median neointimal volume was 1 mm(3) (interquartile range 0 to 13) in SES versus 24 (interquartile range 8 to 34) in BMS (p < 0.001). Target lesion and vessel revascularization rates were significantly reduced, 5.3% versus 21.6% (RR 0.24; 95% CI 0.05 to 1.0, p = 0.047) and 5.3% versus 27% (RR 0.19; 95% CI 0.05 to 0.83, p = 0.012), respectively. Death and myocardial infarction rates were not different. CONCLUSIONS Sirolimus-eluting stents significantly reduce late loss in SVG as opposed to BMS. This is associated with a reduction in restenosis rate and repeated target lesion and vessel revascularization procedures. (The RRISC Study; http://clinicaltrials.gov/ct/show; NCT00263263).
Collapse
Affiliation(s)
- Paul Vermeersch
- Antwerp Cardiovascular Institute Middelheim, AZ Middelheim, Antwerp, Belgium.
| | | | | | | | | | | | | | | |
Collapse
|
19
|
HERMILLER JAMESB. Bypass Graft Disease: Role of Embolic Protection and Drug-Eluting Stents. J Interv Cardiol 2006. [DOI: 10.1111/j.1540-8183.2006.00165.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
20
|
Chu WW, Kuchulakanti PK, Wang B, Clavijo LC, Suddath WO, Pichard AD, Satler LF, Kent KM, Waksman R. Efficacy of sirolimus-eluting stents as compared to paclitaxel-eluting stents for saphenous vein graft intervention. J Interv Cardiol 2006; 19:121-5. [PMID: 16650239 DOI: 10.1111/j.1540-8183.2006.00118.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Saphenous vein graft (SVG) intervention is associated with a significantly increased rate of periprocedural complications and late clinical and angiographic restenosis. In the contemporary drug-eluting stent (DES) era, the comparison of the efficacy of sirolimus-eluting stents (SES) with paclitaxel-eluting stents (PES) in SVG interventions is currently unknown. We conducted this retrospective analysis to investigate this issue. METHODS AND RESULTS Forty-seven patients with 50 SVG lesions who underwent standard percutaneous coronary intervention (PCI) with SES (SES group) were compared with 42 patients with 45 SVG lesions with PES (PES group). All patients received distal protection devices (DPDs) during the interventions. The in-hospital, 30-day, and 6-month clinical outcomes in both groups were compared. Baseline clinical and procedural characteristics were balanced between both groups except for the proximal and mid lesions. There were no deaths or Q-wave myocardial infarctions (MIs) during the index hospitalization. Non-Q-wave MI was similar between the two groups (SES vs PES, 4.3% vs 7.1%, P=0.55). At 30-day and 6-month follow-ups, all the clinical outcomes were similar between the two groups. There was no subacute thrombosis (SAT) or late thrombosis in either group. The event-free survival at 6 months was also similar between both groups (P=0.75). CONCLUSIONS The use of DES in patients undergoing SVG intervention with a DPD is clinically safe and feasible. As compared to SES, PES have the same efficacy and clinical outcomes in SVG interventions up to 6 months.
Collapse
Affiliation(s)
- William W Chu
- Division of Cardiology, Washington Hospital Center, Washington, DC 20010, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Abstract
Percutaneous coronary intervention has evolved dramatically over the past 25 years as coronary stents replaced stand-alone balloon angioplasty. Improvements in stents were made in the 1990s, but a breakthrough occurred in early 2000 with the development of stents that eluted pharmacology agents directly into the vessel wall by means of a controlled release from a durable polymer coating. Various drug-eluting stents were developed,each varying with its delivery platform, polymer coating (or absence of coating),and drug selected for elution. This article describes the clinically available and late developmental drug-eluting stent programs targeted for treating patients who have coronary artery disease.
Collapse
Affiliation(s)
- Jeffrey J Popma
- Department of Internal Medicine (Cardiovascular Division), Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
| | | |
Collapse
|
22
|
Vermeersch P, Agostoni P. Should Degenerated Saphenous Vein Grafts Routinely Be Sealed with Drug-Eluting Stents? J Interv Cardiol 2005; 18:467-73. [PMID: 16336427 DOI: 10.1111/j.1540-8183.2005.00087.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The percutaneous treatment of patients with obstructive atherosclerotic disease in degenerated coronary saphenous vein bypass grafts still remains one of the great challenges in interventional cardiology. In this review, we discuss the actual evidence-based knowledge for the percutaneous management of this lesion subset, focusing in particular on the devices that are actually considered the "gold standard" for this treatment: bare metal stents and distal protection devices. We also comment on the negative results of the randomized trials regarding the promising polytetrafluoroethylene-covered stent-grafts. We finally offer insights into the currently available evidence for the use of drug-eluting stents in saphenous vein grafts. These devices are potentially the principal promise for the long-term successful sealing of vein graft disease; however, clear and definitive data coming from controlled trials are requested.
Collapse
Affiliation(s)
- Paul Vermeersch
- The Department of Cardiology, AZ Middelheim, Antwerp, Belgium.
| | | |
Collapse
|