Adnan Ghufran, Ahmed Intisar, Tai Javed, Khan Maria Ali, Hasan Hammad
Cardiology, Aga Khan University Hospital, Karachi, PAK.
Biostatistics and Epidemiology, Aga Khan University Hospital, Karachi, PAK.
Cureus. 2020 Nov 16;12(11):e11496. doi: 10.7759/cureus.11496.
Background Revascularization of saphenous vein grafts (SVGs) is challenging and debated for the last few decades. The percutaneous revascularization of SVGs was reported to have poorer long-term outcomes than native coronary artery revascularization. Purpose We aim to study the peri-procedural complications and long-term outcomes of the percutaneous revascularization of SVGs in a low-middle-income country. Methods In this retrospective study, we included 110 patients who underwent percutaneous revascularization from January 2011 to March 2020 and followed them retrospectively for long-term outcomes and major adverse cardiovascular events. Results The mean age was 71 ±9, and 81% were male. The most common reason for the presentation was non-ST segment elevation myocardial infarction (NSTEMI) (46%). The mean follow-up period of the study was 48±27 months. The most common comorbidity was hypertension (86%). A drug-eluting stent (80%) was placed in most of the patients, followed by a bare-metal stent (BMS) (14%) and percutaneous balloon angioplasty (POBA) (6%). We did not find any significant difference in major adverse cardiac events (MACE) (P=0.48), target vessel revascularization (TVR) (p=0.69), and target lesion revascularization (TLR) (p=0.54) with drug-eluting stent (DES) as compared to either BMS or POBA. The mean period from coronary artery bypass grafting (CABG) to SVG percutaneous coronary intervention (PCI) was 15± 5.5 years. Multivariate Cox regression analysis showed that an acute coronary syndrome (ACS) event, stroke, and female sex were independently associated with MACE. Conclusion The long-term outcomes of SVG PCI are not affected by the types of stents. Female gender, ACS, and stroke are the independent predictors of MACE after SVG PCI, and statin therapy has a positive impact on the long-term outcomes of SVG PCI.
在过去几十年中，隐静脉移植血管（SVG）的血管重建具有挑战性且存在争议。据报道，SVG的经皮血管重建的长期效果比天然冠状动脉血管重建的效果更差。目的：我们旨在研究在低收入和中等收入国家中SVG经皮血管重建的围手术期并发症和长期效果。方法：在这项回顾性研究中，我们纳入了2011年1月至2020年3月期间接受经皮血管重建的110例患者，并对他们进行长期效果和主要不良心血管事件的回顾性随访。结果：平均年龄为71±9岁，男性占81%。就诊的最常见原因是非ST段抬高型心肌梗死（NSTEMI）（46%）。研究的平均随访期为48±27个月。最常见的合并症是高血压（86%）。大多数患者（80%）植入了药物洗脱支架，其次是裸金属支架（BMS）（14%）和经皮球囊血管成形术（POBA）（6%）。与BMS或POBA相比，我们发现使用药物洗脱支架（DES）在主要不良心脏事件（MACE）（P=0.48）、靶血管重建（TVR）（P=0.69）和靶病变血管重建（TLR）（P=0.54）方面没有显著差异。从冠状动脉旁路移植术（CABG）到SVG经皮冠状动脉介入治疗（PCI）的平均时间为15±5.5年。多变量Cox回归分析表明，急性冠状动脉综合征（ACS）事件、中风和女性性别与MACE独立相关。结论：SVG PCI的长期效果不受支架类型的影响。女性性别、ACS和中风是SVG PCI后MACE的独立预测因素，他汀类药物治疗对SVG PCI的长期效果有积极影响。
