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CLINICAL RESEARCH: CORONARY ARTERY DISEASE

Clinical, angiographic, and intravascular ultrasound characteristics of early saphenous vein graft failure

Daniel A. Caños, MPH^*, Gary S. Mintz, MD, FACC, Chalak O. Berzingi, MD^*, Sue Apple, DNSc, RN^*, Jun-ichi Kotani, MD^*, Augusto D. Pichard, MD, FACC^*, Lowell F. Satler, MD, FACC^*, William O. Suddath, MD, FACC^*, Ron Waksman, MD, FACC^*, Joseph Lindsay, Jr, MD, FACC^* and Neil J. Weissman, MD, FACC^*,*

^* Cardiovascular Research Institute, Washington Hospital Center, Washington, DC, USA
Cardiovascular Research Foundation, New York, New York, USA

Manuscript received March 10, 2003; revised manuscript received March 10, 2004, accepted March 16, 2004.

^* Reprint requests and correspondence: Dr. Neil J. Weissman, Cardiovascular Research Institute, 110 Irving Street NW, Suite 4B-1, Washington, DC 20010, USA.
Neil.J.Weissman{at}medstar.net

OBJECTIVES: We sought to examine saphenous vein graft (SVG) lesions that fail within the first year after operation.

BACKGROUND: Saphenous vein grafts remain patent for approximately 10 years; however, up to 15% to 20% of SVGs become occluded within the first year.

METHODS: We studied 100 patients who underwent percutaneous coronary intervention (PCI) for early (<1 year post-implantation) SVG failure lesions and compared them with a diabetes- and hypercholesterolemia-matched cohort of late SVG failures (>1 year). Coronary angiography and intravascular ultrasound images were analyzed.

RESULTS: The majority of patients in both groups were males who presented with unstable angina; 36% were diabetic. Graft ages were 6.0 ± 2.9 months and 105.4 ± 50.8 months, respectively. The early SVG failure lesion location was more often ostial or proximal (62% vs. 42%, respectively). Early SVG failures were angiographically smaller than late failures (reference: 2.47 ± 0.86 mm vs. 3.26 ± 0.83 mm, p < 0.001) but had similar lesion lengths. Intravascular ultrasound showed that early failure lesions had smaller proximal and distal reference lumen areas (7.3 ± 6.8 mm² vs. 10.6 ± 3.8 mm², p = 0.026) and greater reference plaque burden than late failures (52.3% vs. 36.1%, p < 0.001). After PCI, 20.6% of early and 30.6% of late failure lesions had creatine kinase-myocardial band (CK-MB) greater than twice normal.

CONCLUSIONS: Early SVG failure is mostly proximal or ostial, lesions appear focal, and early SVGs appear smaller than late SVGs. Intravascular ultrasound shows significant reference segment plaque burden, suggesting more severe, diffuse SVG disease.

Abbreviations and Acronyms   CK-MB = creatine kinase-myocardial band   CSA = cross-sectional area   IVUS = intravascular ultrasound   MLD = minimum lumen diameter   PCI = percutaneous coronary intervention   QCA = quantitative coronary angiography   SVG = saphenous vein graft   TIMI = Thrombolysis In Myocardial Infarction

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