Leborgne Laurent, Cheneau Edouard, Pichard Augusto, Ajani Andrew, Pakala Rajbabu, Yazdi Hamid, Satler Lowell, Kent Kenneth, Suddath William O, Pinnow Ellen, Canos Daniel, Waksman Ron
Cardiovascular Research Institute, Division of Cardiology, Washington Hospital Center, Washington, DC 20100, USA.
Am Heart J. 2003 Sep;146(3):501-6. doi: 10.1016/S0002-8703(03)00309-0.
Percutaneous coronary intervention (PCI) of saphenous vein graft (SVG) is associated with frequent postprocedural enzyme elevation and late cardiac events. New strategies are proposed to minimize distal embolization and to improve the outcome of patients treated with stenting for SVG lesions. The objectives of the current study were to examine direct stenting (DS) strategy of PCI in SVG lesions and its effects on creatine-kinase (CK) release, major adverse cardiac events (MACE), and late outcome when compared to conventional stenting (CS).
A consecutive series of 527 patients treated with stent implantation for SVG stenosis was analyzed. In this cohort, 170 patients with 229 lesions were treated with DS and 357 patients with 443 lesions were treated with CS. The inhospital and 12-month follow-up events were recorded and reported.
Baseline clinical and postprocedural angiographic characteristics were similar between the 2 groups except for higher preprocedural prevalence of thrombus-containing lesions in the DS group. Patients in the DS group had less CK-MB release (P <.001), and less non-Q-wave myocardial infarction (P =.024). Multivariate analysis detected unstable angina (odds ratio [OR] = 1.8, P =.03) as a correlate for non-Q-wave MI; DS was inversely associated with non-Q-wave myocardial infarction (OR = 0.65, P =.04). At 1 year, the target lesion revascularization-MACE was significantly lower in the DS group (P =.021). Multivariate analysis showed that DS (OR = 0.47, P =.007) was associated with reduction of the target lesion revascularization-MACE.
When feasible, DS may be the best approach for treating SVG stenosis.
隐静脉搭桥（SVG）的经皮冠状动脉介入治疗（PCI）与术后频繁的酶升高及晚期心脏事件相关。已提出新策略以尽量减少远端栓塞并改善接受SVG病变支架置入治疗患者的预后。本研究的目的是探讨SVG病变PCI的直接支架置入（DS）策略及其与传统支架置入（CS）相比对肌酸激酶（CK）释放、主要不良心脏事件（MACE）及晚期预后的影响。
分析了连续527例接受SVG狭窄支架置入治疗的患者。在该队列中，170例患者的229处病变接受了DS治疗，357例患者的443处病变接受了CS治疗。记录并报告住院期间及12个月随访事件。
两组间基线临床及术后血管造影特征相似，但DS组术前含血栓病变的患病率较高。DS组患者的CK-MB释放较少（P<.001），非Q波心肌梗死较少（P=.024）。多变量分析发现不稳定型心绞痛（优势比[OR]=1.8，P=.03）与非Q波心肌梗死相关；DS与非Q波心肌梗死呈负相关（OR=0.65，P=.04）。1年时，DS组的靶病变血运重建-MACE显著较低（P=.021）。多变量分析显示DS（OR=0.47，P=.007）与靶病变血运重建-MACE的降低相关。
在可行的情况下，DS可能是治疗SVG狭窄的最佳方法。
