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J Am Coll Cardiol, 2001; 38:150-154
© 2001 by the American College of Cardiology Foundation
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CLINICAL STUDY

Are we making progress with percutaneous saphenous vein graft treatment?

A comparison of 1990 to 1994 and 1995 to 1998 results

Mun K. Hong, MD, FACC*, Roxana Mehran, MD, FACC{dagger}, George Dangas, MD, PhD, FACC{dagger}, Gary S. Mintz, MD, FACC{dagger}, Alexandra Lansky, MD, FACC{dagger}, Kenneth M. Kent, MD, PhD, FACC{ddagger}, Augusto D. Pichard, MD, FACC{ddagger}, Lowell F. Satler, MD, FACC{ddagger}, Gregg W. Stone, MD, FACC{dagger} and Martin B. Leon, MD, FACC{dagger}

* Department of Internal Medicine, Division of Cardiology, Cornell University-New York Presbyterian Hospital, New York, New York, USA
{dagger} Cardiovascular Research Foundation, New York, New York, USA
{ddagger} Washington Hospital Center, Washington, DC, USA

Manuscript received December 12, 2000; revised manuscript received March 19, 2001, accepted March 29, 2001.

Reprint requests and correspondence: Dr. Mun K. Hong, Director, Cardiovascular Intervention and Research, Cornell University-New York Presbyterian Hospital, Starr Pavilion 4, 520 East 70th Street, New York, New York 10021
mkh2003{at}med.cornell.edu

OBJECTIVES

We sought to determine whether strategies to reduce procedural distal embolization and late repeat revascularization have resulted in more favorable outcomes after saphenous vein graft (SVG) angioplasty.

BACKGROUND

Angioplasty of SVG lesions has been associated with frequent procedural and late cardiac events. Therefore, evolving strategies have been attempted to improve outcomes after SVG angioplasty.

METHODS

We compared our earlier experience (1990 to 1994) of 1,055 patients with 1,412 SVG lesions with a recent group (1995 to 1998) of 964 patients with 1,315 lesions.

RESULTS

Baseline characteristics were similar between the groups. However, there were significantly more unfavorable lesion characteristics (older, longer and significantly more degenerated SVGs) in the recent series. Between the two periods, there was decreased use of atheroablative devices, whereas stent use increased. The procedural success rates (96.6% vs. 96.1%) were similar. However, one-year outcome (event-free survival) was significantly improved in the more recent experience (70.7% vs. 59.1%, p < 0.0001), especially late mortality (6.1% vs. 11.3%, p < 0.0001). Multivariate analysis showed stent use to be the only protective variable for both periods.

CONCLUSIONS

This study shows that despite higher risk lesions, strategies to reduce distal embolization have maintained high procedural success. Late cardiac events, including mortality, have also been substantially reduced.

Abbreviations and Acronyms
  CK-MB = creatine kinase-MB isoenzyme
  MI = myocardial infarction
  SVG = saphenous vein graft
  TLR = target lesion revascularization




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