Follow-up results after interventional treatment of infarct-related saphenous vein graft occlusion.

BACKGROUND

Acute occlusion of saphenous vein grafts resulting in acute coronary syndromes may be treated with interventional revascularization. Few data are available on intermediate and long-term results after revascularization of acute saphenous vein graft occlusion.

METHODS

Fifty patients (67+/-10 years, 47 male) with troponin-positive acute coronary syndrome because of acute total or subtotal occlusion [thrombolysis in myocardial infarction (TIMI) flow 0=39, TIMI 1=8, TIMI 2=3] of one saphenous vein graft (12.0+/-5.3 years after surgery, 3.6+/-0.9 grafts) were treated with percutaneous coronary intervention (39 patients using bare-metal stents, 11 patients using drug-eluting stents). Clinical follow-up was obtained in all patients. Angiographic 6-month follow-up was performed in 35 patients (70%).

RESULTS

Acute revascularization of the infarct-related saphenous vein graft (lesion length 17.6+/-10.3 mm, reference diameter 3.1+/-0.8 mm) was possible in 94% of patients. After a mean follow-up of 32.5+/-17.4 months, 13 patients (26%) died, 13 patients (26%) had recurrent myocardial infarction, and 20 patients (40%) had recurrent coronary revascularization (percutaneous coronary intervention or coronary artery bypass grafting). Angiographic follow-up showed reocclusion of the vein graft in three cases (9%). Twenty-one percent of lesions were found to be restenotic.

CONCLUSION

Acute revascularization of an infarct-related saphenous vein graft is possible in the majority of cases. Angiographic follow-up data show a high patency rate at 6-month follow-up. Still, the clinical prognosis of patients with revascularized infarct-related saphenous vein graft is quite poor.