Pucelikova Tereza, Mehran Roxana, Kirtane Ajay J, Kim Young-Hak, Fahy Martin, Weisz Giora, Lansky Alexandra J, Moussa Issam, Gray William A, Collins Michael B, Kodali Susheel K, Stone Gregg W, Moses Jeffrey W, Leon Martin B, Dangas George
Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY, USA.
Am J Cardiol. 2008 Jan 1;101(1):63-8. doi: 10.1016/j.amjcard.2007.07.048. Epub 2007 Nov 19.
Percutaneous treatment of saphenous vein graft (SVG) lesions has been associated with higher rates of periprocedural complications and restenosis compared with non-SVG lesions. Whether these outcomes are similar in contemporary clinical practice, particularly when drug-eluting stents are used, is unknown. We evaluated outcomes of 110 consecutive patients who were treated with stent-assisted percutaneous coronary intervention for 145 SVG lesions (drug-eluting stents used in 91.0% of lesions). Embolic protection devices were used in 52.1% of treated grafts. Adverse events were recorded up to 1 year. Major or minor periprocedural myocardial necrosis occurred in 11 patients (10.9%). At 1-year clinical follow-up, we observed 13 myocardial infarctions (13.7%), 8 target lesion revascularizations (8.4%), 18 target vessel revascularizations (19.0%), 2 stent thromboses (2.1%), and 7 deaths (7.4%). The incidence of major adverse cardiac events, defined as death, myocardial infarction, or target vessel revascularization, was 30.5% at 1 year. By multivariable analysis, the presence of thrombus inside the graft before the procedure and the length of the stented segment were independent predictors of major adverse cardiac events at 1 year (hazard ratio for thrombus 4.07, 95% confidence interval 1.90 to 8.68, p = 0.0003; hazard ratio per millimeter of stented length 1.02, 95% confidence interval 1.01 to 1.03, p = 0.025). In conclusion, our data show that patients with SVG lesions remain a high-risk subgroup with worse outcomes after percutaneous coronary intervention compared with native vessel disease even in the era of drug-eluting stents.
与非隐静脉移植物（SVG）病变相比，经皮治疗SVG病变与围手术期并发症和再狭窄发生率较高相关。在当代临床实践中，尤其是使用药物洗脱支架时，这些结果是否相似尚不清楚。我们评估了110例连续接受支架辅助经皮冠状动脉介入治疗145处SVG病变患者的结果（91.0%的病变使用了药物洗脱支架）。52.1%的治疗移植物使用了栓塞保护装置。记录了长达1年的不良事件。11例患者（10.9%）发生了主要或次要围手术期心肌坏死。在1年临床随访时，我们观察到13例心肌梗死（13.7%）、8例靶病变血运重建（8.4%）、18例靶血管血运重建（19.0%）、2例支架血栓形成（2.1%）和7例死亡（7.4%）。1年时，定义为死亡、心肌梗死或靶血管血运重建的主要不良心脏事件发生率为30.5%。通过多变量分析，术前移植物内血栓的存在和支架置入段的长度是1年时主要不良心脏事件的独立预测因素（血栓的风险比为4.07，95%置信区间为1.90至8.68，p = 0.0003；每毫米支架长度的风险比为1.02，95%置信区间为1.01至1.03，p = 0.025）。总之，我们的数据表明，即使在药物洗脱支架时代，与原发性血管疾病相比，SVG病变患者在经皮冠状动脉介入治疗后仍然是一个高风险亚组，预后较差。
