Heart Center of Chonnam National University Hospital, South Korea.
Int J Cardiol. 2013 Jul 15;167(1):29-33. doi: 10.1016/j.ijcard.2011.11.078. Epub 2011 Dec 20.
Little is known about intravascular ultrasound (IVUS) findings and acute post-percutaneous coronary intervention (PCI) outcome and long-term clinical outcome between aorto-ostial lesion and shaft lesion after PCI for saphenous vein graft (SVG) lesions.
Aorto-ostial lesion was defined as those arising within 3mm of the origin of SVG and shaft lesion was defined as those arising in remaining portion of SVG. We evaluated pre- and post-PCI IVUS images of 311 SVG lesions and compared IVUS findings and acute post-PCI outcome and 5-year clinical outcome between aorto-ostial lesion (n=64) and shaft lesion (n=247).
The presence of positive remodeling (40% vs. 22%, p=0.026), hypoechoic plaque (47% vs. 36%, p=0.035), plaque rupture (23% vs. 8%, p=0.008), multiple plaque rupture (9% vs. 2%, p=0.038), and an intraluminal mass (54% vs. 25%, p<0.001) were significantly more common in shaft lesion than in aorto-ostial lesion. Post-PCI no-reflow (15% vs. 5%, p=0.033), post-PCI tissue prolapse (TP) (40% vs. 23%, p=0.014), and post-PCI creatine kinase-MB elevation more than 3 times normal (14% vs. 8%, p=0.047) were observed more frequently after PCI for shaft lesion than for aorto-ostial lesion. At 5-year clinical follow-up, the incidences of death (25% vs. 13%, p=0.036) and myocardial infarction (24% vs. 11%, p=0.028), but not the rate of target vessel revascularization (36% vs. 25%, p=0.096), were significantly higher in patients with shaft lesion compared with those with aorto-ostial lesion.
SVG shaft lesion has more unstable plaque morphology and this may contribute to the worse acute PCI outcomes and long-term outcomes.
对于经皮冠状动脉介入治疗（PCI）后发生于隐静脉桥（SVG）的开口及近段病变和中段病变，关于血管内超声（IVUS）检查所见与急性 PCI 后结果和长期临床结果之间的相关性知之甚少。
开口病变定义为起源于 SVG 3mm 以内的病变，中段病变定义为起源于 SVG 其余部分的病变。我们评估了 311 例 SVG 病变的 PCI 前后 IVUS 图像，并比较了开口病变（n=64）和中段病变（n=247）之间 IVUS 检查所见、急性 PCI 后结果和 5 年临床结果。
中段病变中更常见正性重构（40% vs. 22%，p=0.026）、低回声斑块（47% vs. 36%，p=0.035）、斑块破裂（23% vs. 8%，p=0.008）、多发斑块破裂（9% vs. 2%，p=0.038）和腔内肿块（54% vs. 25%，p<0.001）。与开口病变相比，中段病变的 PCI 后无复流（15% vs. 5%，p=0.033）、PCI 后组织脱垂（TP）（40% vs. 23%，p=0.014）和 PCI 后肌酸激酶同工酶-MB 升高超过正常 3 倍（14% vs. 8%，p=0.047）更为常见。5 年临床随访时，中段病变患者的死亡（25% vs. 13%，p=0.036）和心肌梗死（24% vs. 11%，p=0.028）发生率均高于开口病变患者，但靶血管血运重建率（36% vs. 25%，p=0.096）无显著差异。
SVG 中段病变具有更多不稳定斑块形态学特征，这可能导致更差的急性 PCI 结果和长期结果。
