Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Sep 26, 2021; 13(9): 493-502
Published online Sep 26, 2021. doi: 10.4330/wjc.v13.i9.493
Percutaneous coronary intervention of totally occluded coronary venous bypass grafts: An exercise in futility?
Evan W Nardone, Brandon M Madsen, Melissa M McCarey, David L Fischman, Nicholas J Ruggiero, Paul Walinsky, Alec Vishnevsky, Michael P Savage
Evan W Nardone, David L Fischman, Nicholas J Ruggiero, Paul Walinsky, Alec Vishnevsky, Michael P Savage, Department of Medicine, Thomas Jefferson University, Philadelphia, PA 19107, United States
Brandon M Madsen, Department of Anesthesiology, Medstar Georgetown University Hospital, Washington, DC 20007, United States
Melissa M McCarey, Jefferson Clinical Research Institue, Thomas Jefferson University, Philadelphia, PA 19107, United States
Author contributions: Savage MP, Nardone EW, Madsen BM, Fischman DL and McCarey MM contributed to the design of the research study; Savage MP, Fischman DL, Walinsky P, Ruggiero NJ, and Vishnevsky A acquired the data and conducted the procedures. Nardone EW, Madsen BM, Savage MP and Melissa McCarey performed the research. Savage MP, Nardone EW, Melissa McCarey, Fischman DL, Madsen BM, Ruggiero NJ, Walinsky P, and Vishnevsky A analyzed the data and wrote or revised the manuscript; all authors read and approve the final manuscript.
Institutional review board statement: The retrospective saphenous vein graft study was approved by the IRB at Thomas Jefferson University.
Informed consent statement: This was a retrospective study which did not require written consent.
Conflict-of-interest statement: All authors have no conflicts of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at Consent was not obtained but the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Michael P Savage, FACC, FACP, MD, Director, Professor, Department of Medicine, Thomas Jefferson University, 111 South 11th Street, Philadelphia, PA 19107, United States.
Received: March 23, 2021
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
Research background

Percutaneous coronary intervention (PCI) of diseased saphenous vein grafts (SVG) continues to pose a clinical challenge. Given low success rates, high complication rates, and poor long term patency, current cardiovascular guidelines have a class III recommendation against PCI for chronically occluded SVG.

Research motivation

Contemporary outcomes of SVG intervention have incrementally improved with distal protection devices, intracoronary vasodilators, drug-eluting stents, and prolonged dual antiplatelet therapy. There is a paucity of studies on the outcome of PCI for totally occluded SVG using current techniques.

Research objectives

The goal of this study was to reassess the procedural and long term outcome of PCI for totally occluded SVG with contemporary techniques in the drug-eluting stent era.

Research methods

This was a retrospective observational study of 35 consecutive patients undergoing PCI of totally occluded SVG. The primary outcome was freedom from a major adverse cardiac event (MACE) defined as any of the following: Death, myocardial infarction, stroke, repeat revascularization of the target vessel, or graft reocclusion. Mean follow-up was 1221 ± 1038 d.

Research results

The study group included 29 men and 6 women aged 69 ± 12 years. Mean SVG age was 12 ± 5 years. PCI was initially successful in 29/35 (83%) SVG occlusions. During long term follow-up, MACE-free survival was 30% at 3 years and 17% at 5 years.

Research conclusions

PCI of totally occluded SVG can be performed with a relatively high rate of procedural success. However, the vast majority of patients have a major clinical event within a few years following the procedure. Thus, the clinical utility of PCI for totally occluded SVG continues to be limited by poor long term outcomes.

Research perspectives

Although PCI of totally occluded SVG can be often initially accomplished, the long term clinical outcome remains poor. Future research is required to achieve a more sustained clinical benefit through further innovations in stent design and adjunct pharmacology.