Paul C Ho1, Arthur C Lee, Richard Fortuna. 1. Division of Cardiology, Hawaii Region Kaiser Permanente, 3288 Moanalua Road, Honolulu, Hawaii 96819, USA. paul.c.ho@kp.org
Abstract
BACKGROUND: In post-coronary artery bypass graft (CABG) patients undergoing drug-eluting stent implantation of either the saphenous vein graft (SVG) versus the native coronary artery supplying the same myocardial perfusion territory, which option confers better clinical outcomes when both lesions are technically feasible? METHODS: From 2005 to 2008 at a single medical center, a total of 178 post-CABG patients (with 241 lesions) underwent PCI due to progressive SVG disease. Of them, 23 patients (with 29 lesions) had amenable disease for PCI in both the SVG and native coronary artery matching the same myocardial perfusion territory; chronic total occlusions were excluded. All patients included in the study were treated with drug-eluting stents. Sixteen patients (19 lesions) underwent PCI of the SVG, and 9 patients (10 lesions) underwent PCI in the native vessels. RESULTS: Primary endpoints were in-hospital and 3-year rates of death, myocardial infarction (MI), target lesion revascularization (TLR), and target vessel revascularization (TVR). There were 2 in-hospital MIs in the SVG-treated group and 0 for the native vessel-treated group. The 3-year clinical follow-up showed 3 MIs, 2 TLRs, 4 TVRs, and 6 deaths in the SVG-treated group; only 1 MI occurred in the native-vessel treated group (P=.02). More PCIs of the SVG were performed than in the native coronary artery (19 vs 10 lesions). CONCLUSIONS: This small study suggests improved clinical outcomes with PCI of the native vessel, but a tendency of operators to choose PCI of the SVG instead. Large, prospective, multicenter, randomized clinical trials with long-term follow-up can validate the advantage of selecting PCI of the native vessel over the SVG when both options are available.
BACKGROUND: In post-coronary artery bypass graft (CABG) patients undergoing drug-eluting stent implantation of either the saphenous vein graft (SVG) versus the native coronary artery supplying the same myocardial perfusion territory, which option confers better clinical outcomes when both lesions are technically feasible? METHODS: From 2005 to 2008 at a single medical center, a total of 178 post-CABG patients (with 241 lesions) underwent PCI due to progressive SVG disease. Of them, 23 patients (with 29 lesions) had amenable disease for PCI in both the SVG and native coronary artery matching the same myocardial perfusion territory; chronic total occlusions were excluded. All patients included in the study were treated with drug-eluting stents. Sixteen patients (19 lesions) underwent PCI of the SVG, and 9 patients (10 lesions) underwent PCI in the native vessels. RESULTS: Primary endpoints were in-hospital and 3-year rates of death, myocardial infarction (MI), target lesion revascularization (TLR), and target vessel revascularization (TVR). There were 2 in-hospital MIs in the SVG-treated group and 0 for the native vessel-treated group. The 3-year clinical follow-up showed 3 MIs, 2 TLRs, 4 TVRs, and 6 deaths in the SVG-treated group; only 1 MI occurred in the native-vessel treated group (P=.02). More PCIs of the SVG were performed than in the native coronary artery (19 vs 10 lesions). CONCLUSIONS: This small study suggests improved clinical outcomes with PCI of the native vessel, but a tendency of operators to choose PCI of the SVG instead. Large, prospective, multicenter, randomized clinical trials with long-term follow-up can validate the advantage of selecting PCI of the native vessel over the SVG when both options are available.