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Gupta MD, Gautam A, MP G, Bansal A, Batra V. Primary percutaneous intervention in an unusual vessel using an unusual technique: a case report. Eur Heart J Case Rep 2024; 8:ytae098. [PMID: 38454961 PMCID: PMC10919390 DOI: 10.1093/ehjcr/ytae098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/06/2024] [Accepted: 02/15/2024] [Indexed: 03/09/2024]
Abstract
Background Primary percutaneous intervention (PPCI) of the saphenous vein graft (SVG) is associated with a high risk of distal embolization and no reflow, since SVG lesions are often very friable and have a large thrombotic burden. We report a case of successful PPCI of the SVG using guide catheter thrombectomy with novel double wire technique. Case summary A 60-year-old male with a past history of coronary artery bypass grafting presented with acute thrombotic occlusion of the SVG to the obtuse marginal graft. Despite appropriate pharmacotherapy (GPIIb/IIIa inhibitors) and thrombosuction, there was a large residual thrombus burden with poor distal flow. In the present case, we decided to perform guide catheter thrombosuction. An exchange length floppy 0.014' wire was passed alongside the pre-existing wire and the 6 Fr JR guide catheter was exchanged for a less traumatic 5 Fr JR guide catheter over the exchange wire. The first wire was kept distally in the vessel along the guiding catheter to maintain the access to the graft vessel. The 5 Fr JR guide catheter was slowly advanced over the wire to the distal portion of the graft, keeping the other wire in the distal portion of the graft to maintain access. A large amount of thrombus was aspirated and the patient improved dramatically. Discussion This double wire technique is an effortless and novel way to maintain access to the distal vasculature of the occluded artery, while the guide can be safely intubated deep into the coronary artery that helps in removing a very large amount of thrombus because of their larger internal lumen.
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Affiliation(s)
- Mohit D Gupta
- Department of Cardiology, GB Pant Hospital, 1, Jawaharlal Nehru Marg, 64 Khamba, Raj Ghat, New Delhi 110002, India
| | - Ankur Gautam
- Department of Cardiology, GB Pant Hospital, 1, Jawaharlal Nehru Marg, 64 Khamba, Raj Ghat, New Delhi 110002, India
| | - Girish MP
- Department of Cardiology, GB Pant Hospital, 1, Jawaharlal Nehru Marg, 64 Khamba, Raj Ghat, New Delhi 110002, India
| | - Ankit Bansal
- Department of Cardiology, GB Pant Hospital, 1, Jawaharlal Nehru Marg, 64 Khamba, Raj Ghat, New Delhi 110002, India
| | - Vishal Batra
- Department of Cardiology, GB Pant Hospital, 1, Jawaharlal Nehru Marg, 64 Khamba, Raj Ghat, New Delhi 110002, India
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2
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Dhaduk N, Xia Y, Feit F, Mamas M, Alviar C, Keller N, Rao SV, Bangalore S. In-hospital Outcomes of Patients With and Without Previous Coronary Artery Bypass Graft Surgery Who Present With a Non-ST-Segment Elevation Myocardial Infarction. Am J Cardiol 2023; 194:78-85. [PMID: 36989550 DOI: 10.1016/j.amjcard.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/26/2023] [Accepted: 02/10/2023] [Indexed: 03/31/2023]
Abstract
The clinical course of patients with a previous coronary artery bypass graft surgery (CABG) presenting with non-ST-elevation myocardial infarction (NSTEMI) is not well defined. We aimed to compare the management and outcomes of patients with and without previous CABG who present with an NSTEMI. Patients hospitalized with an NSTEMI between 2002 and 2018 were identified from the National Inpatient Sample. The baseline characteristics and outcomes of patients with and without a previous CABG were compared. The outcomes included the rates of invasive procedures (defined as coronary angiography, percutaneous coronary intervention [PCI], or CABG), and its individual components, and in-hospital mortality. A total of 1,445,545 cases of NSTEMI were found, of which 133,691 (9.3%) had a previous CABG. Patients with a previous CABG were older (72.4 vs 68.6 years, p <0.001), more likely men (68.8% vs 56.9%, p <0.001), and of White race (79.7% vs 74.8%, p <0.001). The previous CABG cohort had lower rates of invasive procedures (50.4% vs 65.6%, p <0.001), PCI (23.7% vs 32.0%, p <0.001), or CABG (1.2% vs 10.6%; p <0.001) in the unmatched analysis. The results were consistent in the propensity score-matched analysis with the previous CABG group less likely to receive any invasive procedures (odds ratio [OR] 0.48, 95% confidence interval [CI] 0.47 to 0.49), including coronary angiography (OR 0.54, 95% CI 0.53 to 0.55), PCI (OR 0.66, 95% CI 0.64 to 0.67), or repeat CABG (OR 0.11, 95% CI 0.10 to 0.12). Moreover, the risk of in-hospital mortality was higher in the previous CABG group (OR 1.15, 95% CI 1.10 to 1.21). In the subset of patients who were revascularized in both groups, this excess mortality was no longer observed (OR 0.82, 95% CI 0.66 to 1.03). In conclusion, a previous CABG in patients who present with NSTEMI is associated with lower rates of invasive procedures and revascularization and higher in-hospital mortality than patients without a previous CABG.
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Affiliation(s)
- Nehal Dhaduk
- The Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York, New York
| | - Yuhe Xia
- Department of Population Health, New York University Langone Medical Center, New York, New York
| | - Frederick Feit
- The Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York, New York
| | - Mamas Mamas
- Department of Cardiology, Keele University, Keele, United Kingdom
| | - Carlos Alviar
- The Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York, New York
| | - Norma Keller
- The Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York, New York
| | - Sunil V Rao
- The Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York, New York
| | - Sripal Bangalore
- The Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York, New York.
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Comparison of Outcomes of Patients with vs without Previous Coronary Artery Bypass Graft Surgery Presenting with ST-Segment Elevation Acute Myocardial Infarction. Am J Cardiol 2021; 154:33-40. [PMID: 34243937 DOI: 10.1016/j.amjcard.2021.05.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/17/2021] [Accepted: 05/24/2021] [Indexed: 11/24/2022]
Abstract
The outcomes of patients with previous coronary bypass graft surgery (CABG) presenting with ST-segment elevation acute myocardial infarction (STEMI) have received limited study. We compared the clinical and procedural characteristics and outcomes of STEMI patients with and without previous CABG in a contemporary multicenter STEMI registry between 2003 and 2020. The primary outcomes of the study were mortality and major cardiac adverse events (MACE: death, MI or stroke). Survival curves were derived using the Kaplan-Meier method and compared with the log-rank test. Of the 13,893 patients included in the analyses, 7.2% had previous CABG. Mean age was 62.4 ± 13.6 years, most patients (71%) were men and 22% had diabetes. Previous CABG patients were older (69.0 ± 11.7 vs 61.9 ± 13.6 years, p <0.001) and more likely to have diabetes (40% vs 21%, p <0.001) compared with patients without previous CABG. Previous CABG patients had higher mortality and MACE at 5 years (p <0.001). Outcomes were similar with saphenous vein graft vs native coronary culprits. Previous CABG remained associated with mortality from discharge to 18 months (p = 0.044) and from 18 months to 5 years (p <0.001) after adjusting for baseline characteristics. Long term outcomes after STEMI were worse among patients with previous CABG compared with patients without previous CABG, even after adjustment for baseline characteristics.
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4
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Xenogiannis I, Zenati M, Bhatt DL, Rao SV, Rodés-Cabau J, Goldman S, Shunk KA, Mavromatis K, Banerjee S, Alaswad K, Nikolakopoulos I, Vemmou E, Karacsonyi J, Alexopoulos D, Burke MN, Bapat VN, Brilakis ES. Saphenous Vein Graft Failure: From Pathophysiology to Prevention and Treatment Strategies. Circulation 2021; 144:728-745. [PMID: 34460327 DOI: 10.1161/circulationaha.120.052163] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Saphenous vein grafts (SVGs) remain the most frequently used conduits in coronary artery bypass graft surgery (CABG). Despite advances in surgical techniques and pharmacotherapy, SVG failure rates remain high, often leading to repeat coronary revascularization. The no-touch SVG harvesting technique (minimal graft manipulation with preservation of vasa vasorum and nerves) reduces the risk of SVG failure, whereas the effect of the off-pump technique on SVG patency remains unclear. Use of buffered storage solutions, intraoperative graft flow measurement, careful selection of the target vessels, and physiological assessment of the native coronary circulation before CABG may also reduce the incidence of SVG failure. Perioperative aspirin and high-intensity statin administration are the cornerstones of secondary prevention after CABG. Dual antiplatelet therapy is recommended for off-pump CABG and in patients with a recent acute coronary syndrome. Intermediate (30%-60%) SVG stenoses often progress rapidly. Stenting of intermediate SVG stenoses failed to improve outcomes; hence, treatment focuses on strict control of coronary artery disease risk factors. Redo CABG is associated with higher perioperative mortality compared with percutaneous coronary intervention (PCI); hence, the latter is preferred for most patients requiring repeat revascularization after CABG. SVG PCI is limited by high rates of no-reflow and a high incidence of restenosis during follow-up. Drug-eluting and bare metal stents provide similar long-term outcomes in SVG PCI. Embolic protection devices reduce no-reflow and should be used when feasible. PCI of the corresponding native coronary artery is associated with better short- and long-term outcomes and is preferred over SVG PCI, if technically feasible.
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Affiliation(s)
- Iosif Xenogiannis
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern, MN (I.X., I.N., E.V., J.K., M.N.B., V.N.B., E.S.B.).,Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Greece (I.X., D.A.)
| | - Marco Zenati
- Division of Cardiac Surgery, Veterans Affairs Boston Healthcare System and Harvard Medical School, Boston, MA (M.A.Z.)
| | - Deepak L Bhatt
- Heart and Vascular Center, Brigham and Women's Hospital, Harvard Medical School, MA (D.L.B.)
| | - Sunil V Rao
- Durham VA Medical Center, Duke University, NC (S.R.)
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (J.R.-C.).,Hospital Clinic of Barcelona, Barcelona, Spain (J.R.-C.)
| | - Steven Goldman
- Sarver Heart Center, University of Arizona, Tucson (S.G.)
| | - Kendrick A Shunk
- San Francisco VA Medical Center, University of California, San Francisco (K.S.)
| | | | - Subhash Banerjee
- VA North Texas Health Care System, University of Texas Southwestern Medical School, Dallas (S.B.)
| | | | - Ilias Nikolakopoulos
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern, MN (I.X., I.N., E.V., J.K., M.N.B., V.N.B., E.S.B.).,Yale School of Medicine, Yale New Haven Hospital (I.N., E.V.)
| | - Evangelia Vemmou
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern, MN (I.X., I.N., E.V., J.K., M.N.B., V.N.B., E.S.B.).,Yale School of Medicine, Yale New Haven Hospital (I.N., E.V.)
| | - Judit Karacsonyi
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern, MN (I.X., I.N., E.V., J.K., M.N.B., V.N.B., E.S.B.)
| | - Dimitrios Alexopoulos
- Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Greece (I.X., D.A.)
| | - M Nicholas Burke
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern, MN (I.X., I.N., E.V., J.K., M.N.B., V.N.B., E.S.B.)
| | - Vinayak N Bapat
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern, MN (I.X., I.N., E.V., J.K., M.N.B., V.N.B., E.S.B.)
| | - Emmanouil S Brilakis
- Center for Coronary Artery Disease, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern, MN (I.X., I.N., E.V., J.K., M.N.B., V.N.B., E.S.B.)
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5
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Adnan G, Ahmed I, Tai J, Khan MA, Hasan H. Long-Term Clinical Outcomes of Percutaneous Coronary Intervention in Saphenous Vein Grafts in a Low to Middle-Income Country. Cureus 2020; 12:e11496. [PMID: 33354442 PMCID: PMC7744211 DOI: 10.7759/cureus.11496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 11/05/2022] Open
Abstract
Background Revascularization of saphenous vein grafts (SVGs) is challenging and debated for the last few decades. The percutaneous revascularization of SVGs was reported to have poorer long-term outcomes than native coronary artery revascularization. Purpose We aim to study the peri-procedural complications and long-term outcomes of the percutaneous revascularization of SVGs in a low-middle-income country. Methods In this retrospective study, we included 110 patients who underwent percutaneous revascularization from January 2011 to March 2020 and followed them retrospectively for long-term outcomes and major adverse cardiovascular events. Results The mean age was 71 ±9, and 81% were male. The most common reason for the presentation was non-ST segment elevation myocardial infarction (NSTEMI) (46%). The mean follow-up period of the study was 48±27 months. The most common comorbidity was hypertension (86%). A drug-eluting stent (80%) was placed in most of the patients, followed by a bare-metal stent (BMS) (14%) and percutaneous balloon angioplasty (POBA) (6%). We did not find any significant difference in major adverse cardiac events (MACE) (P=0.48), target vessel revascularization (TVR) (p=0.69), and target lesion revascularization (TLR) (p=0.54) with drug-eluting stent (DES) as compared to either BMS or POBA. The mean period from coronary artery bypass grafting (CABG) to SVG percutaneous coronary intervention (PCI) was 15± 5.5 years. Multivariate Cox regression analysis showed that an acute coronary syndrome (ACS) event, stroke, and female sex were independently associated with MACE. Conclusion The long-term outcomes of SVG PCI are not affected by the types of stents. Female gender, ACS, and stroke are the independent predictors of MACE after SVG PCI, and statin therapy has a positive impact on the long-term outcomes of SVG PCI.
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Affiliation(s)
- Ghufran Adnan
- Cardiology, Aga Khan University Hospital, Karachi, PAK
| | - Intisar Ahmed
- Cardiology, Aga Khan University Hospital, Karachi, PAK
| | - Javed Tai
- Cardiology, Aga Khan University Hospital, Karachi, PAK
| | - Maria Ali Khan
- Biostatistics and Epidemiology, Aga Khan University Hospital, Karachi, PAK
| | - Hammad Hasan
- Cardiology, Queen Alexandra Hospital, Portsmouth, GBR
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6
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Gharacholou SM, Del-Carpio Munoz F, Motiei A, Sandhu GS, Barsness GW, Gulati R, Wright RS, Pellikka PA, Lewis B, Johnson MP, Lane GE, Pollak PM, Pillai DP, Sabbagh AE, Paul TK, Pham SM, Singh M. Characteristics and Long-Term Outcomes of Patients With Prior Coronary Artery Bypass Grafting Undergoing Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction. Am J Cardiol 2020; 135:1-8. [PMID: 32866446 DOI: 10.1016/j.amjcard.2020.08.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/10/2020] [Accepted: 08/17/2020] [Indexed: 11/19/2022]
Abstract
Limited data are available on characteristics and long-term outcomes of patients with coronary artery bypass grafts (CABG) undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction (STEMI). Between January 2000 to December 2014, we identified STEMI patients with prior CABG undergoing primary percutaneous coronary intervention from 3 sites. Kaplan-Meier methods to estimate survival and major adverse cardiac events (MACE) were employed and compared to a propensity matched cohort of non-CABG STEMI patients. Independent predictors of outcomes were analyzed with Cox modeling. Of the 3,212 STEMI patients identified, there were 296 (9.2%) CABG STEMI patients, having nearly similar frequencies of culprit graft (47.6%) versus culprit native (52.4%) as the infarct-related artery (IRA). At 10 years, the adjusted survival was 44% in CABG STEMI versus 55% in non-CABG STEMI (HR 1.26; 95%CI 0.86 to 1.87; p = 0.72). Survival free of MACE was lower for CABG STEMI (graft IRA, 37%; native IRA, 46%) as compared to non-CABG STEMI controls (63%) (p = 0.02). Neither CABG history nor IRA (native vs graft) was independently associated with death or MACE in multivariable analysis. Temporal trends showed no significant change in death or MACE rates of CABG STEMI patients over time. In conclusion, long term survival of CABG STEMI patients is not significantly different than matched STEMI patients without prior CABG; however, CABG STEMI patients were at significantly higher risk for MACE events.
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Affiliation(s)
| | | | - Arashk Motiei
- Department of Cardiovascular Medicine, Mayo Health System, Mankato, Minnesota
| | - Gurpreet S Sandhu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Gregory W Barsness
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rajiv Gulati
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - R Scott Wright
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Bradley Lewis
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Matthew P Johnson
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Gary E Lane
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida
| | - Peter M Pollak
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida
| | - Dilip P Pillai
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida
| | | | - Timir K Paul
- Division of Cardiology, East Tennessee State University, Johnson City, Tennessee
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Mandeep Singh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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7
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Morici N, De Rosa R, Crimi G, De Luca L, Ferri LA, Lenatti L, Piatti L, Tortorella G, Grosseto D, Franco N, Bossi I, Montalto C, Antonicelli R, Alicandro G, De Luca G, De Servi S, Savonitto S. Characteristics and Outcome of Patients ≥75 Years of Age With Prior Coronary Artery Bypass Grafting Admitted for an Acute Coronary Syndrome. Am J Cardiol 2020; 125:1788-1793. [PMID: 32305223 DOI: 10.1016/j.amjcard.2020.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/08/2020] [Accepted: 03/10/2020] [Indexed: 12/18/2022]
Abstract
The prognostic role of previous coronary artery bypass (CABG) in elderly patients admitted to hospital for an acute coronary syndrome (ACS) is unclear. Therefore, the aim of this study was to compare the prognosis of patients aged ≥75 years admitted for an ACS with or without previous history of CABG. The primary outcome of the study was a composite of overall mortality, recurrent nonfatal myocardial infarction, nonfatal stroke, and rehospitalization for heart failure at 1-year follow-up. We included 2,253 ACS patients, aged 81 (78 to 85) years enrolled in 3 multicenter studies (the Italian Elderly ACS study, the LADIES ACS study, and the Elderly ACS 2 randomised trial) - 178 (7.9%) with previous CABG, 2,075 (92.1%) without. Patients with previous CABG had a higher burden of cardiovascular risk factors, lower ejection fraction, and higher creatinine values on admission. However, both at univariate analysis and after adjustment for the most relevant covariates (sex, age, previous myocardial infarction, type of ACS, left ventricular ejection fraction, and serum creatinine on admission), previous CABG did not show any statistically significant association with 1-year outcome (adjusted hazard ratio 0.85; 95% confidence interval 0.61 to 1.19; p = 0.353). In conclusion, our study suggests that elderly ACS patients with previous CABG have worse basal clinical characteristics. Nevertheless, in a broad cohort of patients mostly treated with percutaneous coronary intervention during the index event, previous CABG did not confer independent additional risk of major adverse cardiovascular events at 1-year follow-up.
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Affiliation(s)
- Nuccia Morici
- Unità di Cure Intensive Cardiologiche, De Gasperis Cardio-Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy.
| | - Roberta De Rosa
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Gabriele Crimi
- Interventional Cardiology Unit, Cardio Thoraco Vascular Department, IRCCS Policlinico San Martino, Genova, Italy
| | - Leonardo De Luca
- Division of Cardiology, S. Giovanni Evangelista Hospital, Rome, Italy
| | - Luca A Ferri
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Lenatti
- Division of Cardiology, Ospedale Manzoni, Lecco, Italy
| | - Luigi Piatti
- Division of Cardiology, Ospedale Manzoni, Lecco, Italy
| | | | | | | | - Irene Bossi
- Unità di Cure Intensive Cardiologiche, De Gasperis Cardio-Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Claudio Montalto
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roberto Antonicelli
- Center of Clinical Pathology and Innovative Therapy, Italian National Research Center on Aging (IRCCS INRCA), Ancona, Italy
| | - Gianfranco Alicandro
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy
| | - Giuseppe De Luca
- Cardiovascular Department, Ospedale "Maggiore della Carità", Eastern Piedmont University, Novara, Italy
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Kheifets M, Vaknin-Assa H, Greenberg G, Assali A, Kornowski R, Perl L. Outcomes of primary percutaneous cardiac intervention for ST elevation myocardial infarction with a saphenous vein graft culprit. Catheter Cardiovasc Interv 2019; 96:E75-E83. [PMID: 31868317 DOI: 10.1002/ccd.28662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/10/2019] [Accepted: 12/07/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Patients treated with primary percutaneous coronary intervention (pPCI) for ST elevation myocardial infarction (STEMI) who have a history of coronary artery bypass grafting (CABG) are at high risk of adverse cardiovascular outcomes. Data on the risk of a saphenous vein graft (SVG)-infarct-related artery (IRA) compared to other culprit vessels are sparse. METHODS The study was based on a prospectively collected registry of 2,405 consecutive patients with STEMI attending a tertiary medical center in 2001-2017. Patients with an SVG-IRA (n = 172) were compared with patients with native vessel disease (n = 2,333) for mortality and major adverse cardiac events (MACE), which included death, myocardial infarction (MI), target vessel revascularization (TVR), and coronary artery bypass surgery (CABG) at 1 month and 3 years. RESULTS The SVG-IRA group was significantly older than the native vessel group (p = .05), with no between-group differences in rates of male patients (76 vs. 82%, p = .59), diabetes (24.2 vs. 26.2%, p = .73), and renal failure (18.8 vs. 9.2%, p = .25). Mortality was higher in the SVG-IRA group at 1 month (13.9 vs. 2.5%, p < .01) and 3 years (23.9 vs. 7.4%, p < .01). At 3 years, SVG-IRA was associated with the highest rates of MACE (55.6%), compared with native vessel disease. After correction for confounders, SVG-IRA remained an independent risk factor for MACE both at 1 month (HR-2.08, 95%CI 1.72-3.11, p < .01) and 3 years (HR-2.01, 95%CI 1.28-3.09, p < .01). CONCLUSION Among patients treated with pPCI for STEMI, outcomes are worse when the culprit is an SVG.
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Affiliation(s)
- Mark Kheifets
- Department of Cardiology, Rabin Medical Center, Petach Tikva and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Internal Medicine B, Meir Medical Center, Kfar-Saba, Israel
| | - Hana Vaknin-Assa
- Department of Cardiology, Rabin Medical Center, Petach Tikva and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gabriel Greenberg
- Department of Cardiology, Rabin Medical Center, Petach Tikva and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abid Assali
- Department of Cardiology, Rabin Medical Center, Petach Tikva and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach Tikva and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leor Perl
- Department of Cardiology, Rabin Medical Center, Petach Tikva and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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9
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Xenogiannis I, Tajti P, Hall AB, Alaswad K, Rinfret S, Nicholson W, Karmpaliotis D, Mashayekhi K, Furkalo S, Cavalcante JL, Burke MN, Brilakis ES. Update on Cardiac Catheterization in Patients With Prior Coronary Artery Bypass Graft Surgery. JACC Cardiovasc Interv 2019; 12:1635-1649. [DOI: 10.1016/j.jcin.2019.04.051] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 03/26/2019] [Accepted: 04/02/2019] [Indexed: 01/30/2023]
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10
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Kaya U, Koza Y. Predictive Value of Mean Platelet Volume in Saphenous Vein Graft Disease. Braz J Cardiovasc Surg 2018; 33:317-322. [PMID: 30184027 PMCID: PMC6122754 DOI: 10.21470/1678-9741-2017-0247] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 02/17/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine whether mean platelet volume (MPV), platelet distribution width (PDW), and platelet count could be used as determinants of mortality following coronary artery bypass graft (CABG) surgery and patency of saphenous vein grafts (SVG). METHODS The records of 128 patients who underwent emergency or elective coronary angiography after CABG surgery, and who died at an early stage were retrospectively reviewed. Patients were divided into three groups as early death, no SVG disease (SVGD), and SVGD group. MPV, PDW, and platelet count were evaluated at different times. RESULTS MPV was significantly higher in the stenotic group than in the nonstenotic group (9.7±1.8 fl and 8.2±0.9 fl, P<0.05). The postoperative MPV ratio was found to be higher in the stenotic group when compared to the preoperative period (9.6±1.8 fl and 7.8±0.9 fl, P<0.05). MPV values were also found to be higher in patients who died during the early stage than in surviving patients (9.4±1.9 fl and 8.0±1.0 fl, P<0.05). There was no statistically significant difference regarding platelet count and PDW ratios between the early deaths group and surviving patients. An MPV value higher than 10.6 predicted SVGD with 85% sensitivity and 45% specificity; and an MPV higher than 7.9 predicted early death with 80% sensitivity and 68% specificity were observed. CONCLUSION MPV may be a useful indicator for the prediction of SVGD and mortality following CABG surgery.
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Affiliation(s)
- Ugur Kaya
- Department of Cardiovascular Surgery, Ataturk University, Faculty of Medicine, Erzurum, Turkey
| | - Yavuzer Koza
- Department of Cardiology, Ataturk University, Faculty of Medicine, Erzurum, Turkey
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11
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Deharo P, Strange JW, Mozid A. Primary percutaneous coronary intervention of native chronic total occlusions to treat ST elevation myocardial infarction secondary to acute vein graft occlusion. Catheter Cardiovasc Interv 2017; 90:251-256. [PMID: 28185396 DOI: 10.1002/ccd.26905] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 11/03/2016] [Accepted: 12/11/2016] [Indexed: 11/09/2022]
Abstract
Primary percutaneous coronary intervention (PCI) is the treatment modality of choice in patients presenting with ST elevation myocardial infarction (STEMI). Clinical outcomes have dramatically improved with the wide adoption of primary PCI in patients with STEMI because of acute thrombotic native coronary artery occlusion. However, patients with prior coronary artery bypass graft (CABG) surgery who present with STEMI because of acute saphenous vein graft (SVG) occlusion continue to have worse outcomes because of poor acute and long-term results of SVG stenting. Therefore, it may be preferable to treat the native coronary artery supplied by the occluded graft although this can be challenging if the native vessel is a chronic total occlusion (CTO). Recent advances in technology and techniques in CTO PCI have significantly improved the success rate and efficiency of CTO procedures. At our institution we have developed a high volume CTO programme with high success rates. We present three cases of acute inferior STEMI because of SVG occlusion which were treated with successful retrograde PCI of the native vessel CTO, utilising the occluded graft as a retrograde channel in two cases and native septal collaterals in the other. Thrombolysis In Myocardial Infarction (TIMI) 3 flow in the native coronary artery was achieved in all three cases with good acute outcomes. Our case series highlights the benefits of a high volume CTO programme. With recent advances in CTO techniques, acute PCI to native vessel CTO is feasible and may be the treatment of choice in selected cases of acute SVG failure. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Pierre Deharo
- Bristol Royal Infirmary, Bristol Heart Institute, Bristol, BS2 8HW, United Kingdom
| | - Julian W Strange
- Bristol Royal Infirmary, Bristol Heart Institute, Bristol, BS2 8HW, United Kingdom
| | - Abdul Mozid
- Bristol Royal Infirmary, Bristol Heart Institute, Bristol, BS2 8HW, United Kingdom
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12
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Bates ER. Misguided Use of Multivariable Analysis to Study Primary Percutaneous Coronary Intervention in Patients With Prior Coronary Artery Bypass Graft. Circ Cardiovasc Interv 2016; 9:e003884. [DOI: 10.1161/circinterventions.116.003884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Eric R. Bates
- From the Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor
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13
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Kohl LP, Garberich RF, Yang H, Sharkey SW, Burke MN, Lips DL, Hildebrandt DA, Larson DM, Henry TD. Outcomes of Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction Patients With Previous Coronary Bypass Surgery. JACC Cardiovasc Interv 2014; 7:981-7. [DOI: 10.1016/j.jcin.2014.04.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 04/10/2014] [Indexed: 11/25/2022]
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14
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Harskamp RE, Kuijt WJ, Damman P, Beijk MA, Grundeken MJ, Woudstra P, Tijssen JG, de Winter RJ. Percutaneous coronary intervention for acute coronary syndrome due to graft failure. Catheter Cardiovasc Interv 2013; 83:203-9. [DOI: 10.1002/ccd.24441] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 04/01/2012] [Indexed: 11/05/2022]
Affiliation(s)
- Ralf E. Harskamp
- Department of Cardiology; Academic Medical Center-University of Amsterdam; Meibergdreef 9, 1105 AZ Amsterdam The Netherlands
| | - Wichert J. Kuijt
- Department of Cardiology; Academic Medical Center-University of Amsterdam; Meibergdreef 9, 1105 AZ Amsterdam The Netherlands
| | - Peter Damman
- Department of Cardiology; Academic Medical Center-University of Amsterdam; Meibergdreef 9, 1105 AZ Amsterdam The Netherlands
| | - Marcel A. Beijk
- Department of Cardiology; Academic Medical Center-University of Amsterdam; Meibergdreef 9, 1105 AZ Amsterdam The Netherlands
| | - Maik J. Grundeken
- Department of Cardiology; Academic Medical Center-University of Amsterdam; Meibergdreef 9, 1105 AZ Amsterdam The Netherlands
| | - Pier Woudstra
- Department of Cardiology; Academic Medical Center-University of Amsterdam; Meibergdreef 9, 1105 AZ Amsterdam The Netherlands
| | - Jan G. Tijssen
- Department of Cardiology; Academic Medical Center-University of Amsterdam; Meibergdreef 9, 1105 AZ Amsterdam The Netherlands
| | - Robbert J. de Winter
- Department of Cardiology; Academic Medical Center-University of Amsterdam; Meibergdreef 9, 1105 AZ Amsterdam The Netherlands
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15
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Harskamp RE, Lopes RD, Baisden CE, de Winter RJ, Alexander JH. Saphenous vein graft failure after coronary artery bypass surgery: pathophysiology, management, and future directions. Ann Surg 2013; 257:824-33. [PMID: 23574989 DOI: 10.1097/sla.0b013e318288c38d] [Citation(s) in RCA: 237] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To review our current understanding of the epidemiology and pathogenesis of vein graft failure (VGF), give an overview of current preventive and interventional measures, and explore strategies that may improve vein graft patency. BACKGROUND VGF and progression of native coronary artery disease limit the long-term efficacy of coronary artery bypass graft surgery. METHODS We reviewed the published literature on the pathophysiology, prevention, and/or treatment of VGF by searching the MEDLINE (January 1, 1966-January 1, 2012), EMBASE (January 1, 1980-January 1, 2012), and Cochrane (January 1, 1995-January 1, 2012) databases. In addition, we reviewed references from the selected articles for studies not identified in the initial search. Basic science and clinical studies were included; non-English language publications were excluded. RESULTS Acute thrombosis, neointimal hyperplasia, and accelerated atherosclerosis are the 3 mechanisms that lead to VGF. Preventive measures include matching and quality assessment of conduit and target vessel, lipid-lowering drugs, antithrombotic therapy, and cessation of smoking. Treatment of VGF includes medical therapy, percutaneous intervention, and redo coronary artery bypass graft surgery. In patients undergoing graft intervention, the use of drug-eluting stents, antiplatelet agents, and embolic protection devices may improve clinical outcomes. CONCLUSIONS Despite advances in management, VGF remains one of the leading causes of poor in-hospital and long-term outcomes after coronary artery bypass graft surgery. New developments in VGF prevention such as gene therapy, external graft support, fully tissue-engineered grafts, hybrid grafts, and synthetic conduits are promising but unproven. Future efforts to reduce VGF require a multidisciplinary approach with a primary focus on prevention.
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Affiliation(s)
- Ralf E Harskamp
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27705, USA
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Nikolsky E, Mehran R, Yu J, Witzenbichler B, Brodie BR, Kornowski R, Brener S, Xu K, Dangas GD, Stone GW. Comparison of outcomes of patients with ST-segment elevation myocardial infarction with versus without previous coronary artery bypass grafting (from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction [HORIZONS-AMI] trial). Am J Cardiol 2013; 111:1377-86. [PMID: 23465098 DOI: 10.1016/j.amjcard.2013.01.285] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 01/20/2013] [Accepted: 01/20/2013] [Indexed: 12/29/2022]
Abstract
The present substudy from the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial assessed the outcomes and their relation to different antithrombotic regimens in patients with previous coronary artery bypass grafting (CABG) treated with primary percutaneous coronary intervention. Of 3,599 patients with information regarding a history of CABG, 105 (2.9%) had previously undergone CABG. Of these 105 patients, 46 were randomized to heparin plus a glycoprotein IIb/IIIa inhibitor and 59 to bivalirudin. The patients with versus without previous CABG were less frequently triaged to primary percutaneous coronary intervention (83.8% vs 93.2%, p = 0.0002) and had a longer door-to-balloon time (median 1.9 vs 1.6 hours, p = 0.047), lower rates of final Thrombolysis In Myocardial Infarction flow grade 2 to 3 in the intervened vessel (92.6% vs 97.8%, p = 0.007), and less frequent rates of complete or partial ST-segment resolution (66.3% vs 77.6%, p = 0.019). At 3 years, previous CABG was associated with a significantly greater incidence of major adverse cardiovascular events (36.4% vs 21.4%, p <0.001) owing to greater rates of mortality (11.2% vs 6.7%, p = 0.08), reinfarction (11.6% vs 7.1%, p = 0.09), stroke (5.1% vs 1.8%, p = 0.013), and ischemic target vessel revascularization (23.6% vs 12.9%, p = 0.005). The outcomes did not differ significantly as a function of the antithrombotic regimen. On multivariate analysis, previous CABG was an independent predictor of 3-year ischemic stroke (hazard ratio 3.57, 95% confidence interval 1.09 to 11.66). Intervention on the saphenous vein graft versus the native vessel predicted 3-year major adverse cardiovascular events (hazard ratio 2.69, 95% confidence interval 1.17 to 6.19). In the HORIZONS-AMI trial, previous CABG was associated with a delay to mechanical reperfusion and lower rates of percutaneous coronary intervention and patency of the infarct related vessel along with worse clinical outcomes.
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Akin I, Wiemer M, Schneider S, Senges J, Hochadel M, Richardt G, Abdel-Wahab M, Kuck KH, Nienaber CA. Real-world experience of drug-eluting stents in saphenous vein grafts compared to native coronary arteries: results from the prospective multicenter German DES.DE registry. Clin Res Cardiol 2011; 101:201-8. [DOI: 10.1007/s00392-011-0381-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Accepted: 11/03/2011] [Indexed: 11/28/2022]
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18
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Jim MH, Ho HH, Ko RLY, Siu CW, Yiu KH, Lau CP, Chow WH. Paclitaxel-eluting stents for chronically occluded saphenous vein grafts (EOS) study. J Interv Cardiol 2011; 23:40-5. [PMID: 20465719 DOI: 10.1111/j.1540-8183.2009.00525.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES The aim of this study was to report the feasibility, short- and medium-term results of percutaneous coronary intervention (PCI) on saphenous vein graft (SVG) chronic total occlusions (CTO) using paclitaxel-eluting stents (PES). BACKGROUND In postbypass patients, PCI on SVG CTO, rather than native vessel CTO, is another treatment option. However, the acute procedural and medium-term outcomes are unknown. METHODS Twenty-two consecutive, symptomatic postbypass patients underwent PCI on SVG CTO; angiographic success was seen in 16 patients (73%). The successful cases were evaluated at 1 year; restudy angiography was performed at 11 +/- 5 months in 15 patients (94%). RESULTS The patients had a mean age of 73 years with predominance of male (68%); the mean SVG age was 14 years. On average, patients received 3.4 PESs per lesion; the stent size was 3.5 +/- 0.4 mm with a total stent length of 98 +/- 34 mm. The use of embolic protection devices and glycoprotein IIb/ IIIa inhibitors was observed in 6 (38%) and 5 (31%) patients, respectively. The in-hospital major adverse cardiac event (MACE) was 13%, accountable by 2 patients with postprocedure myocardial infarction. At follow-up, 6 patients had angiographic restenosis (40%); there was 1 noncardiac death and 3 target vessel revascularizations. The 1-year MACE was 25%; the graft survival free of occlusion and revascularization was 56%. CONCLUSIONS PCI on SVG CTO is a feasible approach with a fairly high success and low in-hospital complication. However, it is associated with a relatively high angiographic restenosis and MACE at 1 year.
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Affiliation(s)
- Man-Hong Jim
- Cardiac Medical Unit, Grantham Hospital, Hong Kong, China
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19
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Gaglia MA, Torguson R, Xue Z, Gonzalez MA, Ben-Dor I, Suddath WO, Kent KM, Satler LF, Pichard AD, Waksman R. Outcomes of patients with acute myocardial infarction rom a saphenous vein graft culprit undergoing percutaneous coronary intervention. Catheter Cardiovasc Interv 2011; 78:23-9. [DOI: 10.1002/ccd.22873] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 10/11/2010] [Accepted: 10/14/2010] [Indexed: 11/11/2022]
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20
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Jim MH, Ho HH, Ko RLY, Siu CW, Yiu KH, Lau CP, Chow WH. Paclitaxel-Eluting Stents for Chronically Occluded Saphenous Vein Grafts (EOS) Study. J Interv Cardiol 2010:JOIC525. [PMID: 20070476 DOI: 10.1111/j.1540-8183.2010.00525.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objectives:The aim of this study was to report the feasibility, short- and medium-term results of percutaneous coronary intervention (PCI) on saphenous vein graft (SVG) chronic total occlusions (CTO) using paclitaxel-eluting stents (PES). Background:In postbypass patients, PCI on SVG CTO, rather than native vessel CTO, is another treatment option. However, the acute procedural and medium-term outcomes are unknown. Methods:Twenty-two consecutive, symptomatic postbypass patients underwent PCI on SVG CTO; angiographic success was seen in 16 patients (73%). The successful cases were evaluated at 1 year; restudy angiography was performed at 11 +/- 5 months in 15 patients (94%). Results:The patients had a mean age of 73 years with predominance of male (68%); the mean SVG age was 14 years. On average, patients received 3.4 PESs per lesion; the stent size was 3.5 +/- 0.4 mm with a total stent length of 98 +/- 34 mm. The use of embolic protection devices and glycoprotein IIb/ IIIa inhibitors was observed in 6 (38%) and 5 (31%) patients, respectively. The in-hospital major adverse cardiac event (MACE) was 13%, accountable by 2 patients with postprocedure myocardial infarction. At follow-up, 6 patients had angiographic restenosis (40%); there was 1 noncardiac death and 3 target vessel revascularizations. The 1-year MACE was 25%; the graft survival free of occlusion and revascularization was 56%. Conclusions:PCI on SVG CTO is a feasible approach with a fairly high success and low in-hospital complication. However, it is associated with a relatively high angiographic restenosis and MACE at 1 year. (J Interven Cardiol 2010;**:1-6).
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Affiliation(s)
- Man-Hong Jim
- Cardiac Medical Unit, Grantham Hospital, Hong Kong, China
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21
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Benamer H, Stratiev V, Schiano P, Sideris G. [Saphenous graft angioplasty]. Ann Cardiol Angeiol (Paris) 2007; 56:269-74. [PMID: 17961491 DOI: 10.1016/j.ancard.2007.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In our daily practice the rate of saphenous graft angioplasty is less than 5%. This kind of angioplasty is more complex with a higher rate of complications in known fragile patients. Some technical trips and tricks are necessary to easily perform these angioplasties. Main difficulties are the extension of saphenous graft lesions, the risk of distal embolism, coronary slow or no flow and the high rate of restenosis. Pharmacological treatment is disappointing with no efficacy of the Gp IIb-IIa blockers. Otherwhise the use of protection devices is clearly effective and must be used when it is technically possible. With the use of bare metal stents in saphenous graft angioplasty the rate of restenosis is very high. There are some encouraging results with drug eluting stents. But we are still now not allowed to use them in this indication in our daily practice.
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Affiliation(s)
- H Benamer
- Service de cardiologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France.
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van der Schaaf RJ, Vis MM, Sjauw KD, Koch KT, Baan J, Tijssen JGP, de Winter RJ, Piek JJ, Henriques JPS. Time from coronary artery bypass surgery does not affect outcome in patients treated with primary angioplasty for acute saphenous vein graft occlusion. Heart 2007; 93:381-2. [PMID: 17322522 PMCID: PMC1861465 DOI: 10.1136/hrt.2006.102020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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