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CLINICAL STUDIES

Procedural results and intermediate clinical outcomes after multiple saphenous vein graft stenting

^a Cardiac Catheterization Laboratory, Division of Cardiology, Washington Hospital Center, Washington, DC, USA

Manuscript received February 1, 1999; revised manuscript received August 24, 1999, accepted October 25, 1999.

Reprint requests and correspondence: Dr. Ran Kornowski, Cardiology Research Foundation, Washington Cardiology Center, Suite 4B-1, 110 Irving Street NW, Washington, DC 20010
RXK3{at}mhg.edu

OBJECTIVES

We evaluated the early and mid-term (18-month) clinical events in a consecutive series of patients undergoing a nonstaged multiple saphenous vein grafting (SVG) intervention with stents as compared with a single SVG stent procedure.

BACKGROUND

Saphenous vein graft angioplasty has been limited by high rates of distal embolization, myocardial infarction, restenosis and late mortality. It is unknown whether stenting of multiple, different SVGs at the same setting is associated with higher risk.

METHODS

We evaluated in-hospital and mid-term clinical outcomes (death, Q wave myocardial infarction [MI] and repeat revascularization rates up to 18 months) in 70 consecutive patients treated with coronary stents in 2 (93% of patients) or 3 SVGs, as compared with 649 patients undergoing stenting of a single SVG between January 1, 1994 and December 31, 1997.

RESULTS

Overall procedural success was obtained in 97% of patients with 2 or 3 SVGs and 97% of patients with a single SVG (p = 0.94). Procedural complications were also similar (2.8% for multiple SVGs vs. 2.7% for a single SVG, p = 0.94). There was a higher prevalence of periprocedural non–Q wave MI (28% vs. 16%, p = 0.009) in the multiple SVG group. During follow-up (18 months), target lesion revascularization was 11% in multiple SVG and 15% in single SVG interventions (p = 0.19), and repeat revascularization (calculated per treated patient) was also similar for both groups (19% vs. 18%, p = 0.94). There was no difference in death (5.6% vs. 5.3%, p = 0.92) and Q wave MI rate (4.3% vs. 2.9%, p = 0.55) after the multiple SVG intervention. Overall cardiac event-free survival was similar for both groups (62% vs. 60%, p = 0.75). The study was powered to detect a clinically meaningful difference of 10% in mortality; smaller differences could not be evaluated on the basis of this sample size.

CONCLUSIONS

Simultaneous stenting of multiple SVGs in carefully selected patients has similar in-hospital procedural success and major complications rates, as well as mid-term (18-month) clinical outcomes, as compared with single SVG stenting. Thus, multiple SVG interventions using stents may be a viable revascularization strategy for carefully selected patients and suitable lesions in multiple SVG disease.

Abbreviations and Acronyms   CABG = coronary artery bypass graft surgery   CK-MB = creatine kinase, MB fraction   ECG = electrocardiogram   IVUS = intravascular ultrasound   MI = myocardial infarction   OR = odds ratio   PTCA = percutaneous transluminal coronary angioplasty   SAVED = SAphenous VEin De novo trial   SVG = saphenous vein graft   TIMI = Thrombolysis in Myocardial Infarction trial

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