Published online Sep 26, 2021. doi: 10.4330/wjc.v13.i9.493
Peer-review started: March 24, 2021
First decision: May 5, 2021
Revised: May 27, 2021
Accepted: July 27, 2021
Article in press: July 27, 2021
Published online: September 26, 2021
Percutaneous coronary intervention (PCI) of diseased saphenous vein grafts (SVG) continues to pose a clinical challenge. Current PCI guidelines give a class III recommendation against performing PCI on chronically occluded SVG. However, contemporary outcomes after SVG intervention have incrementally improved with distal protection devices, intracoronary vasodilators, drug-eluting stents, and prolonged dual antiplatelet therapy.
To reassess the procedural and long-term outcomes of PCI for totally occluded SVG with contemporary techniques.
This was a retrospective observational study conducted at a single university hospital. The study population consisted of 35 consecutive patients undergoing PCI of totally occluded SVG. Post-procedure dual antiplatelet therapy was continued for a minimum of one year and aspirin was continued indefinitely. Clinical outcomes were assessed at a mean follow-up of 1221 ± 1038 d. The primary outcome was freedom from a major adverse cardiac event (MACE) defined as the occurrence of any of the following: death, myocardial infarction, stroke, repeat bypass surgery, repeat PCI, or graft reocclusion.
The study group included 29 men and 6 women with a mean age of 69 ± 12 years. Diabetes was present in 14 (40%) patients. All patients had Canadian Heart Classification class III or IV angina. Clinical presentation was an acute coronary syndrome in 34 (97%) patients. Mean SVG age was 12 ± 5 years. Estimated duration of occlusion was acute (< 24 h) in 34% of patients, subacute (> 24 h to 30 d) in 26%, and late (> 30 d) in 40%. PCI was initially successful in 29/35 SVG occlusions (83%). Total stent length was 52 ± 35 mm. Intraprocedural complications of distal embolization or no-reflow occurred in 6 (17%) patients. During longer term follow-up, MACE-free survival was only 30% at 3 years and 17% at 5 years.
PCI of totally occluded SVG can be performed with a high procedural success rate. However, its clinical utility remains limited by poor follow-up outcomes.
Core Tip: Cardiovascular guidelines give a Class III recommendation against performing percutaneous coronary intervention (PCI) on chronically occluded saphenous vein grafts (SVG). Given contemporary advances in SVG intervention, the goal of this study was to reassess the outcomes of PCI for totally occluded SVG in 35 consecutive patients. PCI was initially successful in 29/35 (83%) SVG occlusions. However, at 3 years only 30% of patients survived without a major cardiac event. Although PCI of totally occluded SVG can be performed with a high procedural success rate, its clinical utility remains limited by poor follow-up outcomes.