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CLINICAL STUDIES

Application of a continuous regression model of restenosis to saphenous vein grafts after successful percutaneous transluminal coronary angioplasty or directional coronary atherectomy

Charles J. Bruce, MD^*, Richard E. Kuntz, MD, Jeffrey J. Popma, MD, FACC, Karen S. Pieper, MS, Eric J. Topol, MD, FACC^|| and David R. Holmes, Jr., MD, FACC^*

^* Division Internal Medicine and Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
Beth Israel Hospital, Boston, Massachusetts, USA
Brigham and Women’s Hospital, Boston, Massachusetts, USA
Pieper Statistical Consulting, Weaverville, North Carolina, USA
^|| Cleveland Clinic Foundation, Cleveland, Ohio, USA

Manuscript received December 3, 1998; revised manuscript received October 6, 1999, accepted November 17, 1999.

Reprint requests and correspondence: Dr. David R. Holmes, Division of Internal Medicine and Cardiovascular Diseases, Mayo Clinic, 200 First Street, Southwest, Rochester, Minnesota 55905

OBJECTIVES

To evaluate a quantitative model of restenosis in patients with vein graft disease undergoing percutaneous transluminal coronary angioplasty (PTCA) or directional coronary atherectomy (DCA).

BACKGROUND

A quantitative relationship between acute gain and late loss has been developed to describe the late changes in lumen dimension after native vessel coronary intervention. This same relationship may also be seen after treatment of saphenous vein graft disease.

METHODS

Patients with native coronary artery stenoses (CAVEAT-I) or saphenous vein graft lesions (CAVEAT-II) were randomized to either DCA or PTCA, and data from these trials were analyzed retrospectively. Angiographic results of the target lesions were reviewed, and each lesion was assessed for vessel caliber and reference diameter, absolute minimal lumen diameter, percent diameter stenosis, percent stenosis of the cross-sectional area, acute gain and late loss. Linear regression models were used to determine late loss and to detect differences in angiographic outcomes.

RESULTS

Vein grafts had significantly larger reference vessel diameters than native coronary arteries; they also had significantly more acute gain and more late loss. Directional coronary atherectomy was associated with a larger acute gain in both studies. Patients undergoing DCA also experienced greater late loss although the effect was statistically significant only in the CAVEAT-I study. After adjusting for the acute gain, the treatment effect on late loss became nonsignificant in both studies.

CONCLUSIONS

In patients undergoing DCA or PTCA of saphenous vein graft narrowings, the relationship between late loss and acute gain is also demonstrated, similar to the device-independent relationships seen in native coronary lesions. In CAVEAT-II, larger degrees of acute gain were also associated with higher degrees of late lumen loss.

Abbreviations and Acronyms   CAVEAT-I = Coronary Angioplasty Versus Excisional Atherectomy Trial-I   CAVEAT-II = Coronary Angioplasty Versus Excisional Atherectomy Trial-II   DCA = directional coronary atherectomy   DS% = percent diameter stenosis   GLM = general linear models   MLD = absolute minimal lumen diameter   PTCA = percutaneous transluminal coronary angioplasty