Abstract 14077: Percutaneous Coronary Intervention of Totally Occluded Venous Bypass Grafts: An Exercise in Futility?
Introduction: Percutaneous coronary intervention (PCI) of diseased saphenous vein grafts (SVG) continues to be a clinical challenge. Current PCI guidelines give a class III recommendation against performing PCI of chronically occluded SVG.
Hypothesis: The goal of this study was to assess the procedural and follow-up outcomes of PCI for totally occluded SVG.
Methods: 35 consecutive patients undergoing intervention of totally occluded SVG were evaluated. Post-procedure, antiplatelet therapy included aspirin indefinitely and dual antiplatelet therapy for a minimum of 1 year. Major adverse cardiac events (MACE) were defined as any of the following: death, stroke, myocardial infarction, repeat bypass surgery, repeat target vessel revascularization, or graft reocclusion.
Results: The study population consisted of 29 men and 6 women with a mean age of 69 ± 12 years. Diabetes was present in 14 (40%) patients. All patients had class III or IV angina. Clinical presentation included STEMI in 17%, NSTEMI in 40%, unstable angina in 40%, and stable angina in 3%. Mean SVG age was 12 ± 5 years. Estimated duration of graft occlusion was acute (≤24 hours) in 34%, subacute (>24 hours to 30 days) in 26%, and late (> 30 days) in 40%. PCI was initially successful in 29/35 SVG occlusions (83%). Mean total stent length was 51 ± 35 mm. Intraprocedural complications of distal embolization or no-reflow occurred in 17%. Event free survival is shown in the Figure. At 3 years, MACE-free survival was only 30%.
Conclusions: Although PCI of totally occluded SVG was performed with a high procedural success rate, follow-up outcomes were poor with the vast majority of patients experiencing a major clinical event within 3 years.
- Percutaneous coronary intervention (PCI)
- Coronary artery bypass grafting (CABG)
- Vein graft disease
Author Disclosures: M.P. Savage: None. E. Nardone: None. D.L. Fischman: None. M. DeCaro: None. N.J. Ruggiero: None. P. Walinsky: None. B.M. Madsen: None. M. McCarey: None.
- © 2016 by American Heart Association, Inc.