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CLINICAL RESEARCH: CORONARY ARTERY DISEASE

Disease Progression in Nonintervened Saphenous Vein Graft Segments

A Serial Intravascular Ultrasound Analysis

Young Joon Hong, MD^_*, Gary S. Mintz, MD, Sang Wook Kim, MD^_*, Sung Yun Lee, MD^_*, Seok Yeon Kim, MD^_*, Teruo Okabe, MD^_*, Augusto D. Pichard, MD^_*, Lowell F. Satler, MD^_*, Ron Waksman, MD^_*, Kenneth M. Kent, MD, PhD^_*, William O. Suddath, MD^_* and Neil J. Weissman, MD^_*,_*

^_* Cardiovascular Research Institute/Medstar Research Institute, Washington Hospital Center, Washington, DC
Cardiovascular Research Foundation, New York, New York

Manuscript received August 18, 2008; revised manuscript received December 2, 2008, accepted December 15, 2008.

^_* Reprint requests and correspondence: Dr. Neil J. Weissman, Washington Hospital Center, 100 Irving Street, Northwest, Suite EB-5123, Washington, DC 20010 (Email: Neil.J.Weissman{at}medstar.net).

Objectives: We used serial intravascular ultrasound (IVUS) to assess disease progression in nonintervened saphenous vein graft (SVG) segments to determine the natural rate of disease progression in SVG.

Background: There are no serial IVUS studies of disease progression or luminal compromise in SVGs.

Methods: We assessed serial (baseline and follow-up at 16.2 ± 7.4 months) IVUS findings in 50 nonintervened SVG segments in 44 patients. The SVG age was 13.5 ± 3.6 years.

Results: Overall, from baseline to follow-up, plaque area increased ( = +0.58 ± 1.25 mm², p = 0.003), and SVG and minimum lumen area (MLA) decreased ( = –0.50 ± 1.14 mm², p = 0.002, and = –1.08 ± 1.28 mm², p < 0.001, respectively). The MLA decreased in 34 lesions ( = –1.67 ± 1.08 mm²), and MLA increased in 16 lesions ( = +0.19 ± 0.47 mm²). Compared with lesions with an increase in MLA, lesions with a decrease in MLA were associated with: 1) larger baseline SVG and plaque areas and plaque burden (15.57 ± 3.90 mm² vs. 11.55 ± 2.30 mm², p < 0.001; 7.97 ± 3.77 mm² vs. 4.27 ± 1.92 mm², p < 0.001; and 48.7 ± 14.2% vs. 36.0 ± 13.4%, p = 0.004, respectively); and 2) a greater decrease in SVG area ( = –0.96 ± 1.05 mm² vs. +0.48 ± 0.58 mm², p < 0.001) and greater increase in plaque area ( = +0.71 ± 1.47 mm² vs. +0.29 ± 0.45 mm², p < 0.001). The MLA correlated with both plaque area (r = –0.589, p < 0.001) and SVG area (r = 0.470, p = 0.001), and plaque area correlated with SVG area (r = 0.436, p = 0.002). There were linear relations between both the plaque area (r = 0.519, p < 0.001) and lumen area (r = –0.500, p < 0.001) versus follow-up low-density lipoprotein (LDL) cholesterol; a follow-up LDL cholesterol of 100 mg/dl predicted no plaque increase.

Conclusions: Lumen loss in nonintervened SVG segments correlated with an increase in plaque area and a decrease in SVG area (plaque growth and negative remodeling) with a linear relationship between plaque growth versus follow-up LDL cholesterol leading to long-term lumen loss.

Key Words: atherosclerosis • plaque • saphenous vein graft • ultrasonics

Abbreviations and Acronyms   IVUS = intravascular ultrasound   LDL = low-density lipoprotein   MLA = minimum lumen area   SVG = saphenous vein graft

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J. Am. Coll. Cardiol. 2009 53: A31. [Full Text] [PDF]