Influence of Lesion Location on Late Clinical Outcomes after Percutaneous Coronary Intervention in Saphenous Vein Grafts

ABSTRACTBackgroundLittle is known about the late clinical outcomes of patients undergoing saphenous vein graft percutaneous coronary intervention (SVG-PCI), and there are controversies regarding the role of lesion location (aorto-ostial or graft body).MethodsSingle-center registry including patients undergoing SVG-PCI between 2006 and 2011. Aorto-ostial lesion was defined as a lesion within the first 8mm of the graft; graft body lesion was defined as a lesion located in the remaining portions of the graft. Interventions approaching only the distal anastomosis or the native coronary bed were excluded. We evaluated the rates of major adverse cardiac events (MACE), death, myocardial infarction (MI), and target vessel revascularization (TVR) between the groups.ResultsOne hundred and ninety-five patients were evaluated, 69 in the Aorto-Ostial Group and 126 in the Graft Body Group. Mean age was 69.6 ± 10.2 years, 41% were diabetic, 65.1% had acute coronary syndromes and most of them were treated with bare metal stents (82.5%). There was no statistical difference between groups for most of the characteristics evaluated. In the late follow-up, the TVR rate (50.8% vs. 22%; P = 0.03) was greater in the Aorto-Ostial Group. The MACE rate (67.7% vs. 63.3%; P = 0.33), death (31.7% vs. 35.6%; P = 0.95) and MI (55% vs. 42%; P = 0.64) were similar between the two groups.ConclusionsThis population included a high-risk subgroup, with high late mortality rates, regardless of the location of the lesion in the graft. In patients treated predominantly by baremetal stents, aorto-ostial lesions had a higher reintervention rate when compared to graft body lesions