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Xenogiannis I, Rangan BV, Uyeda L, Banerjee S, Edson R, Bhatt DL, Goldman S, Holmes DR, Rao SV, Shunk K, Mavromatis K, Ramanathan K, Bavry AA, McFalls EO, Garcia S, Thai H, Uretsky BF, Latif F, Armstrong E, Ortiz J, Jneid H, Liu J, Aggrawal K, Conner TA, Wagner T, Karacsonyi J, Ventura B, Alsleben A, Lu Y, Shih MC, Brilakis ES. In-Stent Restenosis in Saphenous Vein Grafts (from the DIVA Trial). Am J Cardiol 2022; 162:24-30. [PMID: 34736721 DOI: 10.1016/j.amjcard.2021.09.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 12/01/2022]
Abstract
Saphenous vein grafts (SVGs) have high rates of in-stent restenosis (ISR). We compared the baseline clinical and angiographic characteristics of patients and lesions that did develop ISR with those who did not develop ISR during a median follow-up of 2.7 years in the DIVA study (NCT01121224). We also examined the ISR types using the Mehran classification. ISR developed in 119 out of the 575 DIVA patients (21%), with similar incidence among patients with drug-eluting stents and bare-metal stents (BMS) (21% vs 21%, p = 0.957). Patients in the ISR group were younger (67 ± 7 vs 69 ± 8 years, p = 0.04) and less likely to have heart failure (27% vs 38%, p = 0.03) and SVG lesions with Thrombolysis In Myocardial Infarction 3 flow before the intervention (77% vs 83%, p <0.01), but had a higher number of target SVG lesions (1.33 ± 0.64 vs 1.16 ± 0.42, p <0.01), more stents implanted in the target SVG lesions (1.52 ± 0.80 vs 1.31 ± 0.66, p <0.01), and longer total stent length (31.37 ± 22.11 vs 25.64 ± 17.42 mm, p = 0.01). The incidence of diffuse ISR was similar in patients who received drug-eluting-stents and BMS (57% vs 54%, p = 0.94), but BMS patients were more likely to develop occlusive restenosis (17% vs 33%, p = 0.05).
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Affiliation(s)
- Iosif Xenogiannis
- Minneapolis Heart Institute, Abbott Northwestern Hospital Minneapolis, Minnesota
| | - Bavana V Rangan
- Minneapolis Heart Institute, Abbott Northwestern Hospital Minneapolis, Minnesota
| | - Lauren Uyeda
- Palo Alto Cooperative Studies Program Coordinating Center, Palo Alto, California
| | - Subhash Banerjee
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Robert Edson
- Palo Alto Cooperative Studies Program Coordinating Center, Palo Alto, California
| | | | | | - David R Holmes
- Mayo Clinic School of Graduate Medical Education, Rochester, Minnesota
| | - Sunil V Rao
- Durham Veteran Affairs Medical Center, Durham, North Carolina
| | - Kendrick Shunk
- San Francisco Veteran Affairs Medical Center, San Francisco, California
| | | | | | - Antony A Bavry
- North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Edward O McFalls
- Minneapolis Veteran Affairs Medical Center, Minneapolis, Minnesota
| | - Santiago Garcia
- Minneapolis Heart Institute, Abbott Northwestern Hospital Minneapolis, Minnesota; Minneapolis Veteran Affairs Medical Center, Minneapolis, Minnesota
| | - Hoang Thai
- Desert Cardiology of Tucson, Tucson, Arizona
| | - Barry F Uretsky
- John L. McClellan Memorial Veteran Affairs Medical Center, Little Rock, Arkansas
| | - Faisal Latif
- Oklahoma City VA Medical Center, Oklahoma City, Oklahoma
| | | | - Jose Ortiz
- Louis Stokes Cleveland Veteran Affairs Medical Center, Cleveland, Ohio
| | - Hani Jneid
- Michael E. DeBakey Department of Veterans Affairs Medical Center, Houston, Texas
| | - Jayson Liu
- Hines/North Chicago Veteran Affairs Medical Center, Hines, Illinois
| | - Kul Aggrawal
- Harry S. Truman Memorial VA Medical Center, Columbia, Missouri
| | - Todd A Conner
- Veteran Affairs Cooperative Studies Program Clinical Research Pharmacy, Albuquerque, New Mexico
| | - Todd Wagner
- Health Economics Resource Center, VA Palo Alto, California
| | - Judit Karacsonyi
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas; Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | - Beverly Ventura
- Palo Alto Cooperative Studies Program Coordinating Center, Palo Alto, California
| | - Aaron Alsleben
- Palo Alto Cooperative Studies Program Coordinating Center, Palo Alto, California
| | - Ying Lu
- Department of Health Research and Policy, Stanford University, Stanford, California
| | - Mei-Chiung Shih
- Palo Alto Cooperative Studies Program Coordinating Center, Palo Alto, California
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital Minneapolis, Minnesota.
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Danek BA, Karatasakis A, Alame AJ, Nguyen-Trong PKJ, Karacsonyi J, Rangan B, Roesle M, Atwell A, Resendes E, Martinez-Parachini JR, Iwnetu R, Kalsaria P, Siddiqui F, Muller JE, Banerjee S, Brilakis E. Saphenous vein graft near-infrared spectroscopy imaging insights from the lipid core plaque association with clinical events near-infrared spectroscopy (ORACLE-NIRS) registry. Catheter Cardiovasc Interv 2017; 89:E172-E180. [PMID: 27535486 PMCID: PMC5316385 DOI: 10.1002/ccd.26696] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 06/20/2016] [Accepted: 07/11/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVES We sought to examine near-infrared spectroscopy (NIRS) imaging findings of aortocoronary saphenous vein grafts (SVGs). BACKGROUND SVGs are prone to develop atherosclerosis similar to native coronary arteries. They have received little study using NIRS. METHODS We examined the clinical characteristics and imaging findings from 43 patients who underwent NIRS imaging of 45 SVGs at our institution between 2009 and 2016. RESULTS The mean patient age was 67 ± 7 years and 98% were men, with high prevalence of diabetes mellitus (56%), hypertension (95%), and dyslipidemia (95%). Mean SVG age was 7 ± 7 years, mean SVG lipid core burden index (LCBI) was 53 ± 60 and mean maxLCBI4 mm was 194 ± 234. Twelve SVGs (27%) had lipid core plaques (2 yellow blocks on the block chemogram), with a higher prevalence in SVGs older than 5 years (46% vs. 5%, P = 0.002). Older SVG age was associated with higher LCBI (r = 0.480, P < 0.001) and higher maxLCBI4 mm (r = 0.567, P < 0.001). On univariate analysis, greater annual total cholesterol exposure was associated with higher SVG LCBI (r = 0.30, P = 0.042) and annual LDL-cholesterol and triglyceride exposure were associated with higher SVG maxLCBI4 mm (LDL-C: r = 0.41, P = 0.020; triglycerides: r = 0.36, P = 0.043). On multivariate analysis, the only independent predictor of SVG LCBI and maxLCBI4mm was SVG age. SVG percutaneous coronary intervention was performed in 63% of the patients. An embolic protection device was used in 96% of SVG PCIs. Periprocedural myocardial infarction occurred in one patient. CONCLUSIONS Older SVG age and greater lipid exposure are associated with higher SVG lipid burden. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Barbara A Danek
- Cardiology Division, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas
| | - Aris Karatasakis
- Cardiology Division, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas
| | - Aya J Alame
- Cardiology Division, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas
| | | | - Judit Karacsonyi
- Cardiology Division, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas
| | - Bavana Rangan
- Cardiology Division, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas
| | - Michele Roesle
- Cardiology Division, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas
| | - Amy Atwell
- Cardiology Division, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas
| | - Erica Resendes
- Cardiology Division, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas
| | | | - Rahel Iwnetu
- Cardiology Division, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas
| | - Pratik Kalsaria
- Cardiology Division, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas
| | - Furqan Siddiqui
- Cardiology Division, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas
| | - James E Muller
- Vulnerable Plaque and Patient Program, Cardiovascular Disease Program, Center for Integration of Medicine and Innovative Technology, Boston, Massachusetts
| | - Subhash Banerjee
- Cardiology Division, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas
| | - Emmanouil Brilakis
- Cardiology Division, VA North Texas Healthcare System and UT Southwestern Medical Center, Dallas, Texas
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