Document Type : Original Article

Authors

Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran

Abstract

BACKGROUND: Ischemic heart disease (IHD) is the leading cause of 16% of deaths globally. Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are the main treatment options. Saphenous vein grafts (SVGs) remain the most frequently used conduits for CABG. In addition, PCI in cases previously undergoing CABG is related to worse long-term outcomes. This study aimed to evaluate PCI’s short-term and long-term clinical outcomes on SVGs.
METHODS: Sixty-three patients who underwent PCI on SVGs from 2017 to 2019 were enrolled. Short-term and long-term cardiac outcomes of patients in the 6-month follow-up, including major adverse cardiac events (MACE) and all causes of death, were collected. The collected data were also analyzed through statistical methods.
RESULTS: The mean age of the subjects was 63.26 ± 8.74 years. Out of 63 patients, five patients (7.94%) died. Two of them died because of cardiac death a day after PCI, and three other cases passed away during the 6 months after angioplasty. Four and three cases had non-fatal myocardial infarction and stroke 6 months after PCI, respectively.
CONCLUSION: In conclusion, in patients with coronary artery disease, PCI and CABG are complementary therapies. Revascularization on saphenous vein grafts seems to be a safe and practical technique in patients.

Keywords

  1. World Health Organization. The Top 10 Causes of Death 2020, December 9 [Available from: https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death]
  2. Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, et al. 2015 2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention and the 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction. J Am Coll Cardiol. 2016 Mar 15;67(10):1235-50. https://doi.org/10.1016/j.jacc.2015.10.005
  3. Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019 Jan 7;40(2):87-165. https://doi.org/10.1093/eurheartj/ehy394
  4. Patel MR, Calhoon JH, Dehmer GJ, Grantham JA, Maddox TM, Maron DJ, et al. ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate Use Criteria for Coronary Revascularization in Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2017;69(17):2212-41. https://doi.org/10.1016/j.jacc.2017.02.001
  5. Ferrari G, Geijer H, Cao Y, Souza D, Samano N. Percutaneous coronary intervention in saphenous vein grafts after coronary artery bypass grafting: a systematic review and meta-analysis. Scand Cardiovasc J. 2021 Aug;55(4):245-53. https://doi.org/10.1080/14017431.2021.1900598
  6. Xenogiannis I, Zenati M, Bhatt DL, Rao SV, Rodés-Cabau J, Goldman S, et al. Saphenous Vein Graft Failure: From Pathophysiology to Prevention and Treatment Strategies. Circulation. 2021 Aug 31;144(9):728-45. https://doi.org/10.1161/circulationaha.120.052163
  7. Scarsini R, Zivelonghi C, Pesarini G, Vassanelli C, Ribichini FL. Repeat revascularization: Percutaneous coronary intervention after coronary artery bypass graft surgery. Cardiovasc Revasc Med. 2016 Jun;17(4):272-8. https://doi.org/10.1016/j.carrev.2016.04.007
  8. Foster C, Zajarias A. Degenerated Saphenous Vein Graft Intervention: Should We Target the Native Vessel instead? Interv Cardiol Clin. 2013;2(2):323-37. https://doi.org/10.1016/j.iccl.2012.11.005
  9. Dianati Maleki N, Ehteshami Afshar A, Parikh PB. Management of Saphenous Vein Graft Disease in Patients with Prior Coronary Artery Bypass Surgery. Curr Treat Options Cardiovasc Med. 2019 Feb 28;21(2):12. https://doi.org/10.1007/s11936-019-0714-7
  10. McKavanagh P, Yanagawa B, Zawadowski G, Cheema A. Management and prevention of saphenous vein graft failure: a review. Cardiol Ther. 2017;6(2):203-23. https://doi.org/10.1007/s40119-017-0094-6
  11. Harskamp RE, Lopes RD, Baisden CE, de Winter RJ, Alexander JH. Saphenous vein graft failure after coronary artery bypass surgery: pathophysiology, management, and future directions. Ann Surg. 2013;257(5):824-33. https://doi.org/10.1097/sla.0b013e318288c38d
  12. Hara H, Kogame N, Takahashi K, Modolo R, Chichareon P, Tomaniak M, et al. Usefulness of the updated logistic clinical SYNTAX score after percutaneous coronary intervention in patients with prior coronary artery bypass graft surgery: Insights from the GLOBAL LEADERS trial. Catheter Cardiovasc Interv. 2020 Nov;96(5):E516-E26. https://doi.org/10.1002/ccd.28898
  13. van der Heijden LC, Kok MM, Zocca P, Sen H, Löwik MM, Mariani S, et al. Long‐Term Outcome of Consecutive Patients With Previous Coronary Bypass Surgery, Treated With Newer‐Generation Drug‐Eluting Stents. J Am Heart Assoc. 2018;7(3):e007212. https://doi.org/10.1161/jaha.117.007212
  14. Yamaji K, Kimura T, Morimoto T, Nakagawa Y, Inoue K, Nobuyoshi M, et al. Percutaneous coronary intervention in patients with previous coronary artery bypass grafting (from the j-Cypher Registry). Am J Cardiol. 2013 Oct 15;112(8):1110-9. https://doi.org/10.1016/j.amjcard.2013.05.056
  15. Baqi A, Saadia S. Periprocedural and In-Hospital Outcomes Among Percutaneous Coronary Intervention in Saphenous Vein Graft: A Retrospective Observational Study at a Tertiary Care Hospital in South Asian Country. Cureus. 2021 Apr 1;13(4):e14251. https://doi.org/10.7759%2Fcureus.14251
  16. Abdelrahman A, Dębski M, More R, Abdelaziz HK, Choudhury T, Eichhofer J, et al. One-year outcomes of percutaneous coronary intervention in native coronary arteries versus saphenous vein grafts in patients with prior coronary artery bypass graft surgery. Cardiol J. 2022;29(3):396-404. https://doi.org/10.5603%2FCJ.a2020.0131
  17. Kheifets M, Vaknin-Assa H, Greenberg G, Assali A, Kornowski R, Perl L. Outcomes of primary percutaneous cardiac intervention for ST elevation myocardial infarction with a saphenous vein graft culprit. Catheter Cardiovasc Interv. 2020 Jul;96(1):E75-E83. https://doi.org/10.1002/ccd.28662
  18. Rathod KS, Beirne AM, Bogle R, Firoozi S, Lim P, Hill J, et al. Prior Coronary Artery Bypass Graft Surgery and Outcome After Percutaneous Coronary Intervention: An Observational Study From the Pan-London Percutaneous Coronary Intervention Registry. J Am Heart Assoc. 2020 Jun 16;9(12):e014409. https://doi.org/10.1161/jaha.119.014409
  19. Halkin A, Masud AZ, Rogers C, Hermiller J, Feldman R, Hall P, et al. Six-month outcomes after percutaneous intervention for lesions in aortocoronary saphenous vein grafts using distal protection devices: results from the FIRE trial. Am Heart J. 2006 Apr;151(4):915.e1-7. https://doi.org/10.1016/j.ahj.2005.09.018
  20. Liu MJ, Chen CF, Gao XF, Liu XH, Xu YZ. In-hospital outcomes of chronic total occlusion percutaneous coronary intervention in patients with and without prior coronary artery bypass graft: A protocol for systematic review and meta analysis. Medicine (Baltimore). 2020 Jun 5;99(23):e19977. https://doi.org/10.1097/md.0000000000019977
  21. Alidoosti M, Hosseini SK, Sharafi A, Nematipour E, Salarifar M, Poorhoseini H, et al. Outcomes of percutaneous coronary intervention on saphenous vein graft and native coronary vessels. J Tehran Heart Cent. 2011 Summer;6(3):143-7.
  22. Adnan G, Ahmed I, Tai J, Khan MA, Hasan H. Long-Term Clinical Outcomes of Percutaneous Coronary Intervention in Saphenous Vein Grafts in a Low to Middle-Income Country. Cureus. 2020;12(11):e11496. https://doi.org/10.7759%2Fcureus.11496

23. Redfors B, Généreux P, Witzenbichler B, McAndrew T, Diamond J, Huang X, et al. Percutaneous Coronary Intervention of Saphenous Vein Graft. Circ Cardiovasc Interv. 2017 May;10(5):e004953. https://doi.org/10.1161/circinterventions.117.004953