1
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Lin L, Lu W, Wang X, Pan L, Wang X, Zheng X, Li R, Shan Y, Peng M, Qiu C. Short-term outcomes of drug-coated balloon versus drug-eluting stent for de novo saphenous vein graft lesions in coronary heart disease. Front Cardiovasc Med 2023; 10:982880. [PMID: 36950290 PMCID: PMC10025469 DOI: 10.3389/fcvm.2023.982880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 02/17/2023] [Indexed: 03/08/2023] Open
Abstract
Background As a device for percutaneous coronary intervention, drug-coated balloon (DCB) is widely used to treat in-stent restenosis. However, data regarding the use of DCB in treating de novo saphenous vein graft (SVG) lesions are limited. This study aimed to explore the outcomes of using the DCB in the treatment of de novo SVG lesions of coronary heart disease (CHD). Methods This retrospective and observational study analyzed CHD patients with de novo SVG lesions treated with DCB or the new-generation drug-eluting stent (DES) between January 2018 and December 2020. Restenosis was the primary endpoint, whereas target lesion revascularization (TLR), major adverse cardiac events, restenosis, cardiac death, target vessel revascularization, and myocardial infarction were the secondary outcomes. Results We enrolled 31 and 23 patients treated with DCB and DES, respectively. The baseline clinical data, lesion characteristics, and procedural characteristics were similar between the two groups. Twenty-eight (90.3%) patients in the DCB group and 21 (91.3%) in the DES group completed follow-up angiography after 1 year. The quantitative coronary angiography measurements at angiographic follow-up showing late lumen loss were -0.07 ± 0.95 mm for the DCB group and 0.86 ± 0.71 mm for the DES group (P = 0.039), and the rates of restenosis were 13.3% and 21.7% for the DCB and DES groups, respectively (P = 0.470). No significant differences were observed in the rates of MACE (16.7% vs. 26.1%, P = 0.402) and TLR (13.3% vs. 4.3%, P = 0.374) during clinical follow-up. Conclusion Our findings suggest that when pre-dilatation was successful, DCB might be safe and effective in treating de novo SVG lesions.
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2
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Xenogiannis I, Rangan BV, Uyeda L, Banerjee S, Edson R, Bhatt DL, Goldman S, Holmes DR, Rao SV, Shunk K, Mavromatis K, Ramanathan K, Bavry AA, McFalls EO, Garcia S, Thai H, Uretsky BF, Latif F, Armstrong E, Ortiz J, Jneid H, Liu J, Aggrawal K, Conner TA, Wagner T, Karacsonyi J, Ventura B, Alsleben A, Lu Y, Shih MC, Brilakis ES. In-Stent Restenosis in Saphenous Vein Grafts (from the DIVA Trial). Am J Cardiol 2022; 162:24-30. [PMID: 34736721 DOI: 10.1016/j.amjcard.2021.09.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 12/01/2022]
Abstract
Saphenous vein grafts (SVGs) have high rates of in-stent restenosis (ISR). We compared the baseline clinical and angiographic characteristics of patients and lesions that did develop ISR with those who did not develop ISR during a median follow-up of 2.7 years in the DIVA study (NCT01121224). We also examined the ISR types using the Mehran classification. ISR developed in 119 out of the 575 DIVA patients (21%), with similar incidence among patients with drug-eluting stents and bare-metal stents (BMS) (21% vs 21%, p = 0.957). Patients in the ISR group were younger (67 ± 7 vs 69 ± 8 years, p = 0.04) and less likely to have heart failure (27% vs 38%, p = 0.03) and SVG lesions with Thrombolysis In Myocardial Infarction 3 flow before the intervention (77% vs 83%, p <0.01), but had a higher number of target SVG lesions (1.33 ± 0.64 vs 1.16 ± 0.42, p <0.01), more stents implanted in the target SVG lesions (1.52 ± 0.80 vs 1.31 ± 0.66, p <0.01), and longer total stent length (31.37 ± 22.11 vs 25.64 ± 17.42 mm, p = 0.01). The incidence of diffuse ISR was similar in patients who received drug-eluting-stents and BMS (57% vs 54%, p = 0.94), but BMS patients were more likely to develop occlusive restenosis (17% vs 33%, p = 0.05).
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Affiliation(s)
- Iosif Xenogiannis
- Minneapolis Heart Institute, Abbott Northwestern Hospital Minneapolis, Minnesota
| | - Bavana V Rangan
- Minneapolis Heart Institute, Abbott Northwestern Hospital Minneapolis, Minnesota
| | - Lauren Uyeda
- Palo Alto Cooperative Studies Program Coordinating Center, Palo Alto, California
| | - Subhash Banerjee
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Robert Edson
- Palo Alto Cooperative Studies Program Coordinating Center, Palo Alto, California
| | | | | | - David R Holmes
- Mayo Clinic School of Graduate Medical Education, Rochester, Minnesota
| | - Sunil V Rao
- Durham Veteran Affairs Medical Center, Durham, North Carolina
| | - Kendrick Shunk
- San Francisco Veteran Affairs Medical Center, San Francisco, California
| | | | | | - Antony A Bavry
- North Florida/South Georgia Veterans Health System, Gainesville, Florida
| | - Edward O McFalls
- Minneapolis Veteran Affairs Medical Center, Minneapolis, Minnesota
| | - Santiago Garcia
- Minneapolis Heart Institute, Abbott Northwestern Hospital Minneapolis, Minnesota; Minneapolis Veteran Affairs Medical Center, Minneapolis, Minnesota
| | - Hoang Thai
- Desert Cardiology of Tucson, Tucson, Arizona
| | - Barry F Uretsky
- John L. McClellan Memorial Veteran Affairs Medical Center, Little Rock, Arkansas
| | - Faisal Latif
- Oklahoma City VA Medical Center, Oklahoma City, Oklahoma
| | | | - Jose Ortiz
- Louis Stokes Cleveland Veteran Affairs Medical Center, Cleveland, Ohio
| | - Hani Jneid
- Michael E. DeBakey Department of Veterans Affairs Medical Center, Houston, Texas
| | - Jayson Liu
- Hines/North Chicago Veteran Affairs Medical Center, Hines, Illinois
| | - Kul Aggrawal
- Harry S. Truman Memorial VA Medical Center, Columbia, Missouri
| | - Todd A Conner
- Veteran Affairs Cooperative Studies Program Clinical Research Pharmacy, Albuquerque, New Mexico
| | - Todd Wagner
- Health Economics Resource Center, VA Palo Alto, California
| | - Judit Karacsonyi
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas; Division of Invasive Cardiology, Second Department of Internal Medicine and Cardiology Center, University of Szeged, Szeged, Hungary
| | - Beverly Ventura
- Palo Alto Cooperative Studies Program Coordinating Center, Palo Alto, California
| | - Aaron Alsleben
- Palo Alto Cooperative Studies Program Coordinating Center, Palo Alto, California
| | - Ying Lu
- Department of Health Research and Policy, Stanford University, Stanford, California
| | - Mei-Chiung Shih
- Palo Alto Cooperative Studies Program Coordinating Center, Palo Alto, California
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital Minneapolis, Minnesota.
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3
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Beerkens FJ, Singh R, Cao D, Claessen BE, Nicolas J, Sartori S, Snyder C, Camaj A, Giustino G, Power D, Razuk V, Jones D, Tavenier AH, Pivato CA, Nardin M, Chiarito M, Krishnan P, Barman N, Baber U, Sweeny J, Dangas G, Sharma SK, Mehran R, Kini A. Impact of target vessel choice on outcomes following percutaneous coronary intervention in patients with a prior coronary artery bypass graft. Catheter Cardiovasc Interv 2021; 98:E785-E795. [PMID: 34478235 DOI: 10.1002/ccd.29935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/09/2021] [Accepted: 08/21/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To evaluate and compare characteristics and clinical outcomes of percutaneous coronary intervention (PCI) among target vessel types in patients with a prior coronary artery bypass graft (CABG) surgery. BACKGROUND Patients with a prior CABG often require repeat revascularization with PCI. Graft PCI has been associated with worse outcomes compared to native vessel PCI, yet the optimal PCI strategy in prior CABG patients remains unknown. METHODS We stratified prior CABG patients who underwent PCI at a tertiary-care center between 2009 and 2017 by target vessel type: native vessel, venous graft, and arterial graft. The primary outcome of major adverse cardiac events (MACE) was a composite of all-cause death, myocardial infarction, stent thrombosis, or target vessel revascularization up to 1 year post-PCI. RESULTS Prior CABG patients (n = 3983) represented 19.5% of all PCI interventions during the study period. PCI was most frequently performed on native vessels (n = 2928, 73.5%) followed by venous (n = 883, 22.2%) and arterial grafts (n = 172, 4.3%). Procedural success and complications were similar among the groups; however, slow- and no-reflow phenomenon was more common in venous graft PCI compared to native vessel PCI (OR 4.78; 95% CI 2.56-8.95; p < 0.001). At 1 year, there were no significant differences in MACE or in its individual components. CONCLUSIONS Target vessel choice did not appear to affect MACE at 1 year in a large cohort of patients with prior CABG undergoing PCI. Whether PCI of surgical grafts versus native arteries truly results in similar outcomes warrants further investigation in randomized controlled trials.
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Affiliation(s)
- Frans J Beerkens
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ranbir Singh
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Davide Cao
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bimmer E Claessen
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Cardiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Johny Nicolas
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samantha Sartori
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Clayton Snyder
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anton Camaj
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gennaro Giustino
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David Power
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Victor Razuk
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Davis Jones
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anne H Tavenier
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Cardiology, Isala, Zwolle, The Netherlands
| | - Carlo Andrea Pivato
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Matteo Nardin
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mauro Chiarito
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Prakash Krishnan
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nitin Barman
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Usman Baber
- Cardiovascular Disease Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Joseph Sweeny
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - George Dangas
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samin K Sharma
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roxana Mehran
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Annapoorna Kini
- The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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4
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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; 13:e14251. [PMID: 33833936 PMCID: PMC8018860 DOI: 10.7759/cureus.14251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Saphenous vein graft (SVG) may occlude either early or several months to years after coronary artery bypass graft (CABG) surgery. Doing re-do CABG surgery is associated with higher complication and mortality rate as compared to percutaneous coronary intervention (PCI) in SVG. However, PCI of SVG is associated with more periprocedural and in-hospital complications as compared to PCI of native coronary arteries. Due to the scarcity of local data in this regard, this study was designed to estimate the periprocedural and in-hospital outcomes among PCI in SVG. Objectives We aim to study the periprocedural and in-hospital outcomes among patients who underwent PCI in SVG. Methods It is a retrospective observational study. We reviewed hospital record files of 167 consecutive patients, admitted to Aga Khan University Hospital, Karachi, from January 2010 to December 2019, who underwent PCI in SVG. Results Out of 167 patients, 145 (86.8%) were male with a mean age of 72.26 (±8.46) years. Hypertension was the most common comorbid condition. Majority of 141(84.4%) patients presented within 6-10 years since the last CABG done. Seventy-eight (46.7%) patients presented with non-ST elevation myocardial infarction (NSTEMI). Patients who presented with acute coronary syndrome (ACS), 51 (36.9%), and 21 (15.2%) had congestive heart failure and cardiogenic shock on presentation respectively. Coronary angiography was performed in the majority of 155 (92.8%) patients through the femoral artery. The body of the SVG was the most common site affected by the disease. In 88 (52.7%) patients stents were deployed in SVG to obtuse marginal (OM). Drug-eluting stents (DES) were used in 124 (74.3%) patients. 22 (13.2%) of patients developed periprocedural complications, predominantly slow flow and 7 (4.2)% patients had in-hospital complications. Conclusions PCI of SVG is associated with a high procedural success rate and acceptable risk for periprocedural and in-hospital complications. PCI of SVG may be considered as a safe and efficacious option for the percutaneous intervention of SVG lesions.
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Affiliation(s)
- Abdul Baqi
- Cardiology, Aga Khan University Hospital, Karachi, PAK
| | - Sheema Saadia
- Cardiology, Aga Khan University Hospital, Karachi, PAK
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5
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Fahrni G, Farah A, Engstrøm T, Galatius S, Eberli F, Rickenbacher P, Conen D, Mueller C, Pfister O, Twerenbold R, Coslovsky M, Cattaneo M, Kaiser C, Mangner N, Schuler G, Pfisterer M, Möbius-Winkler S, Jeger RV. Long-Term Results After Drug-Eluting Versus Bare-Metal Stent Implantation in Saphenous Vein Grafts: Randomized Controlled Trial. J Am Heart Assoc 2020; 9:e017434. [PMID: 33032485 PMCID: PMC7763393 DOI: 10.1161/jaha.120.017434] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Efficacy data on drug‐eluting stents (DES) versus bare‐metal stents (BMS) in saphenous vein grafts are controversial. We aimed to compare DES with BMS among patients undergoing saphenous vein grafts intervention regarding long‐term outcome. Methods and Results In this multinational trial, patients were randomized to paclitaxel‐eluting or BMS. The primary end point was major adverse cardiac events (cardiac death, nonfatal myocardial infarction, and target‐vessel revascularization at 1 year. Secondary end points included major adverse cardiac events and its individual components at 5‐year follow‐up. One hundred seventy‐three patients were included in the trial (89 DES versus 84 BMS). One‐year major adverse cardiac event rates were lower in DES compared with BMS (2.2% versus 16.0%, hazard ratio, 0.14; 95% CI, 0.03–0.64, P=0.01), which was mainly driven by a reduction of subsequent myocardial infarctions and need for target‐vessel revascularization. Five‐year major adverse cardiac event rates remained lower in the DES compared with the BMS arm (35.5% versus 56.1%, hazard ratio, 0.40; 95% CI, 0.23–0.68, P<0.001). A landmark‐analysis from 1 to 5 years revealed a persistent benefit of DES over BMS (hazard ratio, 0.33; 95% CI, 0.13–0.74, P=0.007) in terms of target‐vessel revascularization. More patients in the BMS group underwent multiple target‐vessel revascularization procedures throughout the study period compared with the DES group (DES 1.1% [n=1] versus BMS 9.5% [n=8], P=0.013). Enrollment was stopped before the target sample size of 240 patients was reached. Conclusions In this randomized controlled trial with prospective long‐term follow‐up of up to 5 years, DES showed a better efficacy than BMS with sustained benefits over time. DES may be the preferred strategy in this patient population. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00595647.
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Affiliation(s)
| | - Ahmed Farah
- Klinikum Westfalen Dortmund Germany.,Central Clinic Bad Berka Germany
| | | | - Søren Galatius
- Bispebjerg University Hospital Copenhagen Denmark.,Gentofte Hospital Hellerup Denmark
| | | | | | - David Conen
- University Hospital Basel Switzerland.,Population Health Research Institute McMaster University Hamilton Canada
| | | | | | | | | | | | | | - Norman Mangner
- Herzzentrum Dresden Technische Universität Dresden Dresden Germany.,Heart Center University of Leipzig Germany
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6
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Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferovic PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J 2020; 40:87-165. [PMID: 30165437 DOI: 10.1093/eurheartj/ehy394] [Citation(s) in RCA: 3832] [Impact Index Per Article: 958.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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7
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Towards a Saphenous Vein Graft Moratorium. Cardiol Rev 2020; 28:236-239. [DOI: 10.1097/crd.0000000000000277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Conte SM, Florisson DS, De Bono JA, Vale PR. Drug-eluting versus bare-metal stents for saphenous vein graft lesions. Intern Med J 2019; 49:1534-1537. [PMID: 31808253 DOI: 10.1111/imj.14659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/12/2019] [Accepted: 05/20/2019] [Indexed: 11/28/2022]
Abstract
A best evidence topic was written addressing the question 'in patients with saphenous vein graft lesions requiring percutaneous coronary intervention, do long-term clinical outcomes differ between drug-eluting and bare-metal stents?' Altogether 1466 papers were found, of which seven represented the best evidence. Although one major recent randomised trial was neutral, the weight of earlier evidence supports drug-eluting stents as standard of care. Bare-metal stents may represent a reasonable, efficacious, and less expensive alternative to drug-eluting stents in well selected patient groups.
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Affiliation(s)
- Sean M Conte
- Department of Medicine, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia.,University of New South Wales, School of Medicine, Sydney, New South Wales, Australia.,Notre Dame Australia, School of Medicine, Sydney, New South Wales, Australia
| | - Daniel S Florisson
- Department of Cardiothoracics, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Joshua A De Bono
- Department of Cardiothoracics, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Peter R Vale
- Notre Dame Australia, School of Medicine, Sydney, New South Wales, Australia.,Department of Cardiology, Mater Hospital, Sydney, New South Wales, Australia
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9
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Abstract
An estimated 400,000 coronary artery bypass graft operations are performed annually in the United States. Saphenous vein grafts are the most commonly used conduits; however, graft failure is common. In contrast, left internal mammary artery grafts have more favorable long-term patency rates. Guidelines recommend aggressive secondary prevention. In the 2 decades following surgery, 16% of patients require repeat revascularization, and percutaneous coronary intervention accounts for 98% of procedures performed. Post-coronary artery bypass graft patients presenting with symptoms of acute coronary syndrome or progressive heart failure should undergo early coronary angiography given the high likelihood that such a presentation represents graft failure. Percutaneous coronary intervention in degenerated saphenous vein grafts is associated with embolization that may cause the "no-reflow phenomenon," which can be avoided with the use of embolic protection devices. Hybrid revascularization procedures are a promising emerging strategy to avoid the placement of vein grafts.
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10
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Xenogiannis I, Tajti P, Hall AB, Alaswad K, Rinfret S, Nicholson W, Karmpaliotis D, Mashayekhi K, Furkalo S, Cavalcante JL, Burke MN, Brilakis ES. Update on Cardiac Catheterization in Patients With Prior Coronary Artery Bypass Graft Surgery. JACC Cardiovasc Interv 2019; 12:1635-1649. [DOI: 10.1016/j.jcin.2019.04.051] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 03/26/2019] [Accepted: 04/02/2019] [Indexed: 01/30/2023]
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11
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Affiliation(s)
- Michael P Savage
- Department of Medicine (Cardiology), Thomas Jefferson University Hospital, Philadelphia, PA
| | - David L Fischman
- Department of Medicine (Cardiology), Thomas Jefferson University Hospital, Philadelphia, PA
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12
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Efficacy Over Time With Drug-Eluting Stents in Saphenous Vein Graft Lesions. J Am Coll Cardiol 2019; 71:1973-1982. [PMID: 29724350 DOI: 10.1016/j.jacc.2018.03.456] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/14/2018] [Accepted: 03/13/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND In the ISAR-CABG (Is Drug-Eluting-Stenting Associated with Improved Results in Coronary Artery Bypass Grafts?) trial, clinical outcomes at 1 year in patients undergoing treatment of saphenous vein graft lesions were superior with drug-eluting stents (DES) versus bare-metal stents. OBJECTIVES The authors compared outcomes between treatment groups at 5 years. METHODS Patients were randomized (1:1:1:3) to receive DES (either permanent-polymer paclitaxel-eluting stents, permanent-polymer sirolimus-eluting stents, or biodegradable-polymer sirolimus-eluting stents) or bare-metal stents. The primary endpoint was the combined incidence of death, myocardial infarction (MI), or target lesion revascularization (TLR). Secondary endpoints were the composite of death or MI and TLR. RESULTS A total of 610 patients were allocated to treatment with DES (n = 303) or bare-metal stents (n = 307). At 5 years, the primary endpoint occurred in 159 (55.5%) versus 157 (53.6%) patients in the DES and bare-metal stent groups, respectively (hazard ratio [HR]: 0.98; 95% confidence interval [CI]: 0.79 to 1.23; p = 0.89). There was interaction between treatment effect and time (pinteraction = 0.005), with a lower event rate in the DES group at 1 year (HR: 0.64; 95% CI: 0.44 to 0.94; p = 0.02) but a numerically higher rate between 1 and 5 years (HR: 1.24; 95% CI: 0.94 to 1.63; p = 0.13). Death or MI occurred in 93 (32.8%) versus 108 (36.6%) patients, respectively (HR: 0.85; 95% CI: 0.64 to 1.12; p = 0.24), without significant interaction between treatment effect and time (pinteraction = 0.57). TLR occurred in 84 (33.1%) versus 69 (25.5%) patients in the DES and bare-metal stent groups, respectively (HR: 1.20; 95% CI: 0.87 to 1.64; p = 0.27). There was interaction between treatment effect and time (pinteraction <0.001): TLR was significantly lower in the DES group at 1 year (HR: 0.49; 95% CI: 0.28 to 0.86; p = 0.01) but significantly higher thereafter (HR: 2.02; 95% CI: 1.32 to 3.08; p = 0.001). CONCLUSIONS In patients undergoing treatment of saphenous vein graft lesions, the advantage of DES over bare-metal stents demonstrated at 1 year was lost at 5 years due to higher attrition of efficacy in the DES group. (Efficacy Study of Drug-Eluting and Bare Metal Stents in Bypass Graft Lesions [ISAR-CABG]; NCT00611910).
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13
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Shah R, Hesterberg K. Drug-eluting stents versus bare-metal stents for saphenous vein graft interventions. J Thorac Dis 2019; 11:S1257-S1260. [PMID: 31245102 DOI: 10.21037/jtd.2019.02.50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Rahman Shah
- Department of Medicine, University of Tennessee, School of Medicine, Memphis, TN, USA.,Department of Cardiology, Veterans Affairs Medical Center, Memphis, TN, USA
| | - Kirstin Hesterberg
- Department of Medicine, University of Tennessee, School of Medicine, Memphis, TN, USA.,Department of Cardiology, Veterans Affairs Medical Center, Memphis, TN, USA
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14
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Kang SH, Gogas BD, Jeon KH, Park JS, Lee W, Yoon CH, Suh JW, Hwang SS, Youn TJ, Chae IH, Kim HS. Long-term safety of bioresorbable scaffolds: insights from a network meta-analysis including 91 trials. EUROINTERVENTION 2019; 13:1904-1913. [PMID: 29278353 DOI: 10.4244/eij-d-17-00646] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIMS The aim of this study was to investigate the long-term safety and efficacy of biodegradable scaffolds and metallic stents. METHODS AND RESULTS We analysed a total of 91 randomised controlled trials with a mean follow-up of 3.7 years in 105,842 patients which compared two or more coronary metallic stents or biodegradable scaffolds and reported the long-term clinical outcomes (≥2 years). Network meta-analysis showed that patients treated with the Absorb bioresorbable vascular scaffold (BVS) had a significantly higher risk of definite or probable scaffold thrombosis (ScT) compared to those treated with metallic DES. The risk of very late ScT was highest with the Absorb BVS among comparators. Pairwise conventional meta-analysis demonstrated that the elevated risk of ScT with Absorb BVS compared to cobalt-chromium everolimus-eluting stents was consistent across the time points of ≤30 days (early), 31 days - 1 year (late) and >1 year (very late) ScT. In addition, target lesion failure rates were significantly higher in the Absorb BVS cohort, driven by both increased risk of target vessel myocardial infarction and ischaemia-driven target lesion revascularisation. CONCLUSIONS Absorb BVS implantation was associated with increased risk of long-term and very late ScT compared to current-generation metallic DES. The risk of ScT occurred with a rising trend beyond one year.
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Affiliation(s)
- Si-Hyuck Kang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
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Dianati Maleki N, Ehteshami Afshar A, Parikh PB. Management of Saphenous Vein Graft Disease in Patients with Prior Coronary Artery Bypass Surgery. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:12. [DOI: 10.1007/s11936-019-0714-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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16
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Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferović PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. EUROINTERVENTION 2019; 14:1435-1534. [PMID: 30667361 DOI: 10.4244/eijy19m01_01] [Citation(s) in RCA: 300] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Franz-Josef Neumann
- Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
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17
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Garg A, Rout A, Tayal R, Sharma A, Agrawal S, Kostis JB, Cohen M, Sharma S, Wasty N. Drug-eluting Stents Versus Bare-metal Stents for Saphenous Vein Graft Interventions: A Systematic Review and Meta-analysis of Studies With Longer Follow-up. Curr Probl Cardiol 2019; 46:100405. [PMID: 30792045 DOI: 10.1016/j.cpcardiol.2018.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 12/15/2018] [Indexed: 10/27/2022]
Abstract
Randomized controlled trials comparing drug eluting stents (DES) with bare-metal stents (BMS) for saphenous vein graft (SVG) interventions have shown conflicting results. We conducted this meta-analysis to evaluate the cumulative evidence for long-term efficacy and safety of DES vs BMS in SVG lesions. A systematic search was conducted of Randomized controlled trials comparing DES vs BMS in patients undergoing percutaneous interventions for SVG lesions. End-points of interest were all-cause death, cardiac death, myocardial infarction, target lesion revascularization and target vessel revascularization at longest available follow-up. Random effects meta-analysis was conducted to estimate risk ratio with 95% confidence intervals for individual end-points. Seven studies with 1639 patients were included in the final analysis. Mean follow-up period was 32 months. Compared with BMS, DES was associated with similar risks of all-cause death (risk ratio 1.06; 95% confidence intervals 0.76-1.48) and cardiac death (0.95; 0.59-1.54). Similarly, there were no differences between DES and BMS in terms of myocardial infarction (0.81; 0.50-1.29), target vessel revascularization (0.73; 0.48-1.110 or target lesion revascularization (1.05; 0.76-1.43). Current analysis suggests no strong evidence for routine DES use in patients undergoing SVG intervention. Future studies should evaluate if SVG lesion characteristics could influence these results.
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Liu Y, Yang F, Zou S, Qu L. Rapamycin: A Bacteria-Derived Immunosuppressant That Has Anti-atherosclerotic Effects and Its Clinical Application. Front Pharmacol 2019; 9:1520. [PMID: 30666207 PMCID: PMC6330346 DOI: 10.3389/fphar.2018.01520] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/11/2018] [Indexed: 12/20/2022] Open
Abstract
Atherosclerosis (AS) is the leading cause of stroke and death worldwide. Although many lipid-lowering or antiplatelet medicines have been used to prevent the devastating outcomes caused by AS, the serious side effects of these medicines cannot be ignored. Moreover, these medicines are aimed at preventing end-point events rather than addressing the formation and progression of the lesion. Rapamycin (sirolimus), a fermentation product derived from soil samples, has immunosuppressive and anti-proliferation effects. It is an inhibitor of mammalian targets of rapamycin, thereby stimulating autophagy pathways. Several lines of evidence have demonstrated that rapamycin possess multiple protective effects against AS through various molecular mechanisms. Moreover, it has been used successfully as an anti-proliferation agent to prevent in-stent restenosis or vascular graft stenosis in patients with coronary artery disease. A thorough understanding of the biomedical regulatory mechanism of rapamycin in AS might reveal pathways for retarding AS. This review summarizes the current knowledge of biomedical mechanisms by which rapamycin retards AS through action on various cells (endothelial cells, macrophages, vascular smooth muscle cells, and T-cells) in early and advanced AS and describes clinical and potential clinical applications of the agent.
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Affiliation(s)
- Yandong Liu
- Department of Vascular and Endovascular Surgery, Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai, China
| | - Futang Yang
- Department of Vascular and Endovascular Surgery, Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai, China
| | - Sili Zou
- Department of Vascular and Endovascular Surgery, Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai, China
| | - Lefeng Qu
- Department of Vascular and Endovascular Surgery, Changzheng Hospital Affiliated to the Second Military Medical University, Shanghai, China
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Núñez-Gil IJ, Alfonso E, Salinas P, Nombela-Franco L, Ramakrishna H, Jimenez-Quevedo P, Escaned J, Gonzalo N, de Agustin JA, Vivas D, Feltes G, Macaya C, Fernández-Ortiz A. Internal mammary artery graft failure: Clinical features, management, and long-term outcomes. Indian Heart J 2019; 70 Suppl 3:S329-S337. [PMID: 30595285 PMCID: PMC6309709 DOI: 10.1016/j.ihj.2018.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 08/02/2018] [Accepted: 08/16/2018] [Indexed: 11/22/2022] Open
Abstract
Objective Data on long-term outcomes after internal mammary artery (IMA) coronary graft failure are scarce. Our objective was to describe the clinical characteristics, management, and prognosis after angiographically confirmed IMA graft failure following coronary revascularization. Methods A three-hospital retrospective registry, observational and descriptive, with prospective follow-up of all consecutive cases of IMA graft failure between 2004 and 2014 was conducted. After treatment, clinical and procedural features were compared between those with and without cardiovascular events. Results Fifty-seven patients were included (89% male, mean age: 62 years, at surgery) in the registry. Most patients underwent an IMA angioplasty (percutaneous coronary intervention [PCI], 74%). In nine cases, the PCI failed at the graft level, and seven underwent a native vessel revascularization. Native vessel treatment was performed in 20% of the study subjects, all with stents. Finally, medical management was decided in three cases. Events after treatment for IMA graft failure were frequent (50.8%), during a median follow-up of 7.5 years. Acute presentation (hazard ratioMACE = 1.35; 95% confidence interval (CI): 1.12–3.00, p < 0.01), age of the patient (hazard ratioMACE = 1.85, 95% CI: 1.17–2.11, p < 0.01), presence of diabetes mellitus (hazard ratioMACE = 2.75, 95% CI: 1.13–6.69, p = 0.02), and the management modality used (IMA-simple angioplasty VS IMA-stenting: hazard ratioMACE = 5.5, 95% CI: 1.40–21.15, p = 0.01) displayed prognostic relevance on multivariate analysis. All-cause mortality occurred in 21.1% and presentation as infarction (hazard ratioDEATH = 1.05, 95% CI: 1.01–2.17, p = 0.01), age (hazard ratioDEATH = 9.08, 95% CI: 2.52–32.69, p < 0.01), and left ventricular ejection fraction (hazard ratioDEATH = 3.68, 95% CI: 1.65–8.18, p < 0.01) were independent predictors of the same. Conclusions In this long-term registry, most patients presented with an acute condition (myocardial infarction, progressive angina) within 12 months after surgery. Acute presentation, age, diabetes mellitus, reduced left ventricular ejection fraction, IMA graft failure segment affected, and the management strategy were related with long-term prognosis.
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Affiliation(s)
- Iván J Núñez-Gil
- Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain.
| | - Emilio Alfonso
- Cardiology, Instituto de Cardiología y Cirugía Cardiovascular, La Habana, Cuba
| | - Pablo Salinas
- Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Luis Nombela-Franco
- Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Harish Ramakrishna
- Department of Anesthesiology and Cardiology, Mayo Clinic, Phoenix, AZ, USA
| | | | - Javier Escaned
- Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Nieves Gonzalo
- Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | | | - David Vivas
- Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Gisela Feltes
- Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Carlos Macaya
- Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
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20
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Bhogal S, Panchal HB, Bagai J, Banerjee S, Brilakis ES, Mukherjee D, Kumar G, Shanmugasundaram M, Paul TK. Drug-Eluting Versus Bare Metal Stents in Saphenous Vein Graft Intervention: An Updated Comprehensive Meta-Analysis of Randomized Trials. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 20:758-767. [PMID: 30503811 DOI: 10.1016/j.carrev.2018.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/31/2018] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Drug eluting stents (DES) are preferred over bare metal stents (BMS) for native coronary artery revascularization unless contraindicated. However, the preferred stent choice for saphenous venous graft (SVG) percutaneous coronary interventions (PCI) is unclear due to conflicting results. METHODS PubMed, Clinical trials registry and the Cochrane Center Register of Controlled Trials were searched through June 2018. Seven studies (n = 1639) comparing DES versus BMS in SVG-PCI were included. Endpoints were major adverse cardiac events (MACE), cardiovascular mortality, all-cause mortality, myocardial infarction (MI), target vessel revascularization (TVR), target lesion revascularization (TLR), in-stent thrombosis, binary in-stent restenosis, and late lumen loss (LLL). RESULTS Overall, during a mean follow up of 32.1 months, there was no significant difference in the risk of MACE, cardiovascular mortality, all-cause mortality, MI, stent thrombosis, TVR and TLR between DES and BMS. However, short-term follow up (mean 11 months) showed lower rate of MACE (OR 0.66 [0.51, 0.85]; p = 0.002), TVR (OR 0.47 [0.23, 0.97]; p = 0.04) and binary in-stent restenosis (OR 0.14 [0.06, 0.37]; p < 0.0001) in DES as compared with BMS. This benefit was lost on long-term follow up with a mean follow up 35.5 months. CONCLUSION In this meta-analysis of SVG-PCI, DES use was associated with similar MACE, cardiovascular mortality, all-cause mortality, MI, in-stent thrombosis, TVR and TLR compared with BMS during long-term follow up. There was high incidence of MACE noted in both DES and BMS suggesting a need for exploring novel strategies to treat SVG disease to improve clinical outcomes.
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Affiliation(s)
- Sukhdeep Bhogal
- Division of Cardiology, Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Hemang B Panchal
- Division of Cardiology, Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Jayant Bagai
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Subhash Banerjee
- VA North Texas Health Care System, University of Texas Southwestern Medical Center at Dallas, TX, USA
| | | | - Debabrata Mukherjee
- Division of Cardiology, Department of Internal Medicine, Texas Tech University, TX, USA
| | - Gautam Kumar
- Emory University School of Medicine, Atlanta VA Medical Center, Atlanta, GA, USA
| | | | - Timir K Paul
- Division of Cardiology, Department of Internal Medicine, East Tennessee State University, Johnson City, TN, USA.
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21
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Long-term outcomes of drug-eluting stents versus bare metal stents in saphenous vein graft interventions. Evidence from a meta-analysis of randomized controlled trials. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:951-955. [DOI: 10.1016/j.carrev.2018.07.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/13/2018] [Accepted: 07/23/2018] [Indexed: 11/18/2022]
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Shah R, Jovin IS, Latham SB, Hesterberg K, Heckle MR, Rashid A, Vetrovec GW. A comprehensive meta-analysis of randomized controlled trials comparing drug-eluting stents with bare-metal stents in saphenous vein graft interventions. Catheter Cardiovasc Interv 2018; 92:1229-1236. [PMID: 30051628 DOI: 10.1002/ccd.27687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 03/20/2018] [Accepted: 05/15/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Several large randomized controlled trials (RCTs) have proven the superiority of drug-eluting stents (DESs) over bare-metal stents (BMSs) for native coronary stenosis. However, RCTs comparing DESs with BMSs for SVG lesions have predominantly been small in size and have yielded conflicting results. Therefore, we conducted an updated comprehensive meta-analysis of RCTs comparing DESs versus BMSs for SVG interventions using the largest sample size to date. METHODS Scientific databases and websites were searched to find RCTs. Data from six RCTs involving 1,582 patients were included. Pooled risk ratios (RRs) were calculated using random-effects models. The primary outcome of this meta-analysis was target vessel revascularization (TVR). The secondary outcomes were major adverse cardiac events (MACEs), myocardial infarction (MI), stent thrombosis, all-cause mortality, and cardiac mortality. RESULTS Data from six RCTs involving 1,582 patients were included. Saphenous vein graft interventions with DESs reduced TVR (RR, 0.52; 95% CI, 0.30-0.88; P = 0.017) and MACE rate (RR, 0.60; 95% CI, 0.42-0.87; P = 0.007) compared to BMSs. No difference between the stents were found in rates of MI (RR, 0.69; 95% CI, 0.43-1.10; P = 0.123), stent thrombosis (RR, 0.61; 95% CI, 0.27-1.41; P = 0.255), all-cause mortality (RR, 1.13; 95% CI, 0.74-1.71; P = 0.554), or cardiac mortality. CONCLUSION For SVG intervention, the MACE rate was lower for DESs compared to BMSs, driven primarily by decreased non-MI-related TVR. Rates of MI, all-cause mortality, cardiac mortality, and stent thrombosis were not different between the stents.
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Affiliation(s)
- Rahman Shah
- Division of Cardiology, University of Tennessee, School of Medicine, Memphis, Tennessee
| | - Ion S Jovin
- Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia
| | - Samuel B Latham
- Division of Cardiology, University of Tennessee, School of Medicine, Memphis, Tennessee
| | - Kirstin Hesterberg
- Division of Cardiology, University of Tennessee, School of Medicine, Memphis, Tennessee
| | - Mark R Heckle
- Division of Cardiology, University of Tennessee, School of Medicine, Memphis, Tennessee
| | - Abdul Rashid
- Jackson Clinic, University of Tennessee, Jackson, Tennessee
| | - George W Vetrovec
- Division of Cardiology, Virginia Commonwealth University, Richmond, Virginia
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Hicks CW, Canner JK, Lum YW, Perler BA, Black JH, Abularrage CJ. Drug-eluting stents are associated with improved outcomes for the treatment of infrainguinal bypass graft stenoses. J Vasc Surg 2018; 69:875-882. [PMID: 30497859 DOI: 10.1016/j.jvs.2018.08.189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 08/29/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Existing endovascular therapies for failing infrainguinal bypass grafts are associated with modest patency rates. The use of everolimus drug-eluting stents (eDESs) for endovascular bypass graft revision has not yet been reported. The objective of this study was to describe and to compare clinical outcomes of eDESs vs percutaneous cutting balloons (PCBs) vs percutaneous transluminal angioplasty (PTA) for the treatment of infrainguinal bypass graft stenoses. METHODS A multicenter, single-institution retrospective analysis of patients with infrainguinal bypass graft stenoses treated by endovascular intervention (August 2010-December 2017) was conducted. The primary study outcome was primary patency of the treated lesion. The secondary outcome was limb salvage. Outcomes are described overall and stratified by endovascular treatment modality using Kaplan-Meier curves and log-rank tests. RESULTS During the 7-year study period, 43 patients with 78 infrainguinal bypass stenoses were treated by endovascular intervention (eDES, 15; PCB, 23; PTA, 40). Mean age was 63.3 ± 1.7 years, 53.5% were male, and 55.8% were black. The majority of patients were diabetic (60.5%) with a history of smoking (74.4%), and nearly all (83.7%) had two or more comorbidities. Half (48.7%) of bypasses treated were femoral-popliteal bypasses, followed by popliteal-distal (25.6%) and femoral-tibial (25.6%) configurations. The location of revision was the proximal anastomosis in 37.2%, midbypass in 25.6%, and distal anastomosis in 37.2%. There were no significant differences in baseline characteristics, bypass configuration, or revision location between treatment groups (P ≥ .19). Technical success for endovascular bypass intervention was 100%. At 2 years after intervention, primary patency was significantly better for patients treated with eDES (81.8%) compared with PCB (54.7%) or PTA (33.2%; log-rank, P = .03). Limb salvage was achieved in 93.6% of patients, including 86.7%, 91.3%, and 97.5% for eDES, PCB, and PTA, respectively (P = .30). CONCLUSIONS This is the first study reporting the results of eDESs for the treatment of infrainguinal bypass graft stenoses. Use of eDESs for endovascular bypass graft revision not only is feasible but may have better primary patency than other endovascular therapies. These data suggest that eDESs may be considered a safe and efficacious endovascular technique in the armamentarium for treatment of infrainguinal bypass graft stenoses.
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Affiliation(s)
- Caitlin W Hicks
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Md
| | - Joseph K Canner
- Center for Surgical Trials and Outcomes Research, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Md
| | - Ying W Lum
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Md
| | - Bruce A Perler
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Md
| | - James H Black
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Md
| | - Christopher J Abularrage
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Md.
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Ha FJ, Nogic J, Montone RA, Cameron JD, Nerlekar N, Brown AJ. Drug eluting versus bare metal stents for percutaneous coronary intervention of saphenous vein graft lesions: An updated meta-analysis of randomized controlled trials. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:837-844. [DOI: 10.1016/j.carrev.2018.03.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 03/16/2018] [Accepted: 03/27/2018] [Indexed: 10/17/2022]
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Almomani A, Pothineni NV, Edupuganti M, Payne J, Agarwal S, Uretsky B, Hakeem A. Outcomes of Fractional Flow Reserve-Based Deferral in Saphenous Vein Graft Narrowing. Am J Cardiol 2018; 122:723-728. [PMID: 30064860 DOI: 10.1016/j.amjcard.2018.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 05/14/2018] [Accepted: 05/18/2018] [Indexed: 11/19/2022]
Abstract
Fractional flow reserve (FFR) has been shown to improve clinical decision-making for revascularization in intermediate coronary stenosis in native coronary arteries of patients with stable coronary disease. However, its use for saphenous vein graft (SVG) lesions has not been well validated. We sought to determine the prognostic value of deferring intervention in lesions with FFR >0.8 in SVG lesions. Clinical, angiographic, and hemodynamic variables and long-term outcomes were recorded in consecutive patients in whom percutaneous coronary intervention was deferred based on an FFR >0.8 for intermediate native coronary artery or SVG stenosis. Thirty-three patients underwent FFR of SVG lesions and were compared with 532 patients who underwent native vessel FFR during the same period. There were no differences in age (66.6 [interquartile range, IQR 63 to 76] vs 65 years [IQR 61 to 70]; p = 0.12), diabetes (41% vs 50%; p = 0.35), or hypertension (94% vs 97%; p = 0.71). During a median follow-up of 3.2 years (IQR 1.7 to 4.6 years) major adverse cardiac event was significantly higher in SVG group (36% vs 21%; log rank p = 0.01). Similarly, the rate of target vessel failure was significantly higher in the SVG group (27% vs 14%; p = 0.01). Deferred SVG lesions had the worst survival free of target vessel failure compared with deferred native lesions in both patients with and without previous CABG. An SVG lesion was an independent predictor of major adverse cardiac events on Cox proportional hazards analysis (hazard ratio 2.26; confidence interval 1.19, 4.28; p = 0.01). In conclusion, nonischemic FFR carries a significantly worse prognosis in SVG compared with non-SVG lesions. Caution is warranted in utilizing FFR for clinical decision-making in SVG lesions.
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Affiliation(s)
- Ahmed Almomani
- Central Arkansas VA Health System, Little Rock, Arkansas
| | | | | | - Jason Payne
- Central Arkansas VA Health System, Little Rock, Arkansas
| | - Shiv Agarwal
- Central Arkansas VA Health System, Little Rock, Arkansas
| | - Barry Uretsky
- Central Arkansas VA Health System, Little Rock, Arkansas
| | - Abdul Hakeem
- Central Arkansas VA Health System, Little Rock, Arkansas; Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
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Sousa-Uva M, Neumann FJ, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferovic PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO. 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur J Cardiothorac Surg 2018; 55:4-90. [PMID: 30165632 DOI: 10.1093/ejcts/ezy289] [Citation(s) in RCA: 347] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Elgendy IY, Mahmoud AN, Brilakis ES, Bavry AA. Drug-eluting stents versus bare metal stents for saphenous vein graft revascularisation: a meta-analysis of randomised trials. EUROINTERVENTION 2018; 14:215-223. [DOI: 10.4244/eij-d-17-00839] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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28
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Brilakis ES, Edson R, Bhatt DL, Goldman S, Holmes DR, Rao SV, Shunk K, Rangan BV, Mavromatis K, Ramanathan K, Bavry AA, Garcia S, Latif F, Armstrong E, Jneid H, Conner TA, Wagner T, Karacsonyi J, Uyeda L, Ventura B, Alsleben A, Lu Y, Shih MC, Banerjee S. Drug-eluting stents versus bare-metal stents in saphenous vein grafts: a double-blind, randomised trial. Lancet 2018; 391:1997-2007. [PMID: 29759512 PMCID: PMC6402785 DOI: 10.1016/s0140-6736(18)30801-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/16/2018] [Accepted: 03/21/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Few studies have examined the efficacy of drug-eluting stents (DES) for reducing aortocoronary saphenous vein bypass graft (SVG) failure compared with bare-metal stents (BMS) in patients undergoing stenting of de-novo SVG lesions. We assessed the risks and benefits of the use of DES versus BMS in de-novo SVG lesions. METHODS Patients were recruited to our double-blind, randomised controlled trial from 25 US Department of Veterans Affairs centres. Eligible participants were aged at least 18 years and had at least one significant de-novo SVG lesion (50-99% stenosis of a 2·25-4·5 mm diameter SVG) requiring percutaneous coronary intervention with intent to use embolic protection devices. Enrolled patients were randomly assigned, in a 1:1 ratio, by phone randomisation system to receive a DES or BMS. Randomisation was stratified by presence or absence of diabetes and number of target SVG lesions requiring percutaneous coronary intervention (one or two or more) within each participating site by use of an adaptive scheme intended to balance the two stent type groups on marginal totals for the stratification factors. Patients, referring physicians, study coordinators, and outcome assessors were masked to group allocation. The primary endpoint was the 12-month incidence of target vessel failure, defined as the composite of cardiac death, target vessel myocardial infarction, or target vessel revascularisation. The DIVA trial is registered with ClinicalTrials.gov, number NCT01121224. FINDINGS Between Jan 1, 2012, and Dec 31, 2015, 599 patients were randomly assigned to the stent groups, and the data for 597 patients were used. The patients' mean age was 68·6 (SD 7·6) years, and 595 (>99%) patients were men. The two stent groups were similar for most baseline characteristics. At 12 months, the incidence of target vessel failure was 17% (51 of 292) in the DES group versus 19% (58 of 305) in the BMS group (adjusted hazard ratio 0·92, 95% CI 0·63-1·34, p=0·70). Between-group differences in the components of the primary endpoint, serious adverse events, or stent thrombosis were not significant. Enrolment was stopped before the revised target sample size of 762 patients was reached. INTERPRETATION In patients undergoing stenting of de-novo SVG lesions, no significant differences in outcomes between those receiving DES and BMS during 12 months of follow-up were found. The study results have important economic implications in countries with high DES prices such as the USA, because they suggest that the lower-cost BMS can be used in SVG lesions without compromising either safety or efficacy. FUNDING US Department of Veterans Affairs Cooperative Studies Program.
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Affiliation(s)
- Emmanouil S Brilakis
- VA North Texas Health Care System, Dallas, TX, USA; Minneapolis Heart Institute, Minneapolis, MN, USA; University of Texas Southwestern Medical School, Dallas, TX, USA.
| | - Robert Edson
- VA Cooperative Studies Program Coordinating Center, Mountain View, CA, USA
| | - Deepak L Bhatt
- VA Boston Healthcare System, Boston, MA, USA; Brigham and Women's Hospital Heart and Vascular Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Steven Goldman
- University of Arizona, Sarver Heart Center, Tucson, AZ, USA
| | - David R Holmes
- Mayo Clinic School of Graduate Medical Education, Rochester, MN, USA
| | - Sunil V Rao
- Durham VA Medical Center, Durham, NC, USA; Duke University, Durham, NC, USA
| | - Kendrick Shunk
- San Francisco VA Medical Center, San Francisco, CA, USA; University of California San Francisco, San Francisco, CA, USA
| | - Bavana V Rangan
- VA North Texas Health Care System, Dallas, TX, USA; University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Kreton Mavromatis
- Atlanta VA Medical Center, Atlanta, GA, USA; Emory University, Atlanta, GA, USA
| | - Kodangudi Ramanathan
- Memphis VA Medical Center, Memphis, TN, USA; University of Tennessee, Memphis, TN, USA
| | - Anthony A Bavry
- North Florida/South Georgia Veterans Health System, Gainesville, FL, USA; University of Florida, Gainesville, FL, USA
| | - Santiago Garcia
- Minneapolis VA Medical Center, Minneapolis, MN, USA; University of Minnesota, Minneapolis, MN, USA
| | - Faisal Latif
- Oklahoma VA Medical Center, Oklahoma City, OK, USA; University of Oklahoma, Oklahoma City, OK, USA
| | - Ehrin Armstrong
- Denver VA Medical Center, Denver, CO, USA; University of Colorado, Denver, CO, USA
| | - Hani Jneid
- Michael E DeBakey VA Medical Center, Houston, TX, USA; Baylor College of Medicine, Houston, TX, USA
| | - Todd A Conner
- VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, NM, USA
| | - Todd Wagner
- VA Health Economics Resource Center, Menlo Park, CA, USA; Department of Surgery, Stanford University, CA, USA
| | - Judit Karacsonyi
- VA North Texas Health Care System, Dallas, TX, USA; University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Lauren Uyeda
- VA Cooperative Studies Program Coordinating Center, Mountain View, CA, USA
| | - Beverly Ventura
- VA Cooperative Studies Program Coordinating Center, Mountain View, CA, USA
| | - Aaron Alsleben
- VA Cooperative Studies Program Coordinating Center, Mountain View, CA, USA
| | - Ying Lu
- Department of Health Research and Policy, Stanford University, Stanford, CA, USA
| | - Mei-Chiung Shih
- VA Cooperative Studies Program Coordinating Center, Mountain View, CA, USA; Department of Health Research and Policy, Stanford University, Stanford, CA, USA
| | - Subhash Banerjee
- VA North Texas Health Care System, Dallas, TX, USA; University of Texas Southwestern Medical School, Dallas, TX, USA
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Redfors B, Généreux P, Witzenbichler B, McAndrew T, Diamond J, Huang X, Maehara A, Weisz G, Mehran R, Kirtane AJ, Stone GW. Percutaneous Coronary Intervention of Saphenous Vein Graft. Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.117.004953. [PMID: 28495896 DOI: 10.1161/circinterventions.117.004953] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 04/14/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) of saphenous vein grafts (SVGs) has historically been associated with a high risk of adverse ischemic events, but there is a paucity of contemporary data on the second-generation drug-eluting stent use within SVG, and the relative importance of high platelet reactivity (HPR) in SVG PCI versus native lesion PCI is unknown. We studied ischemic and bleeding events after SVG PCI and their association with HPR. METHODS AND RESULTS Subjects in the prospective, multicenter ADAPT-DES study (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) were stratified according to whether they had PCI of an SVG or a non-SVG lesion. Two-year outcomes were compared between groups using univariate and multivariable Cox proportional hazards models. HPR was defined as on-clopidogrel P2Y12 platelet reaction units >208 as measured by the VerifyNow assay; major adverse cardiac events were defined as the composite of cardiac death, myocardial infarction, or stent thrombosis. Among 8582 subjects in ADAPT-DES, 405 (4.7%) had SVG PCI. SVG PCI was independently associated with a higher 2-year risk of major adverse cardiac events (adjusted hazard ratio, 2.34; 95% confidence interval, 1.69-3.23; P<0.0001), ischemia-driven target vessel revascularization (adjusted hazard ratio, 1.82; 95% confidence interval, 1.37-2.42; P<0.0001), and stent thrombosis (adjusted hazard ratio, 2.26; 95% confidence interval, 1.42-3.59; P=0.0006), but not of bleeding (adjusted hazard ratio, 0.99; 95% confidence interval, 0.68-1.46; P=0.97). There was no statistical interaction between HPR and SVG PCI in regard to major adverse cardiac events (adjusted Pinteraction=0.99). CONCLUSIONS SVG PCI is associated with a considerably higher risk of 2-year adverse ischemic events, with HPR conferring similar risk in SVG and non-SVG PCI. More potent and longer antiplatelet therapy may be beneficial for patients undergoing SVG PCI. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00638794.
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Affiliation(s)
- Björn Redfors
- From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (B.R., P.G., T.M., X.H., A.M., G.W., R.M., A.J.K., G.W.S.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center (J.D., A.M., G.W., A.J.K., G.W.S.); Gagnon Cardiovascular Institute, Morristown Medical Center, NJ (P.G.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Quebec, Canada (P.G.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
| | - Philippe Généreux
- From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (B.R., P.G., T.M., X.H., A.M., G.W., R.M., A.J.K., G.W.S.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center (J.D., A.M., G.W., A.J.K., G.W.S.); Gagnon Cardiovascular Institute, Morristown Medical Center, NJ (P.G.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Quebec, Canada (P.G.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.).
| | - Bernhard Witzenbichler
- From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (B.R., P.G., T.M., X.H., A.M., G.W., R.M., A.J.K., G.W.S.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center (J.D., A.M., G.W., A.J.K., G.W.S.); Gagnon Cardiovascular Institute, Morristown Medical Center, NJ (P.G.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Quebec, Canada (P.G.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
| | - Thomas McAndrew
- From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (B.R., P.G., T.M., X.H., A.M., G.W., R.M., A.J.K., G.W.S.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center (J.D., A.M., G.W., A.J.K., G.W.S.); Gagnon Cardiovascular Institute, Morristown Medical Center, NJ (P.G.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Quebec, Canada (P.G.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
| | - Jamie Diamond
- From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (B.R., P.G., T.M., X.H., A.M., G.W., R.M., A.J.K., G.W.S.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center (J.D., A.M., G.W., A.J.K., G.W.S.); Gagnon Cardiovascular Institute, Morristown Medical Center, NJ (P.G.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Quebec, Canada (P.G.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
| | - Xin Huang
- From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (B.R., P.G., T.M., X.H., A.M., G.W., R.M., A.J.K., G.W.S.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center (J.D., A.M., G.W., A.J.K., G.W.S.); Gagnon Cardiovascular Institute, Morristown Medical Center, NJ (P.G.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Quebec, Canada (P.G.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
| | - Akiko Maehara
- From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (B.R., P.G., T.M., X.H., A.M., G.W., R.M., A.J.K., G.W.S.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center (J.D., A.M., G.W., A.J.K., G.W.S.); Gagnon Cardiovascular Institute, Morristown Medical Center, NJ (P.G.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Quebec, Canada (P.G.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
| | - Giora Weisz
- From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (B.R., P.G., T.M., X.H., A.M., G.W., R.M., A.J.K., G.W.S.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center (J.D., A.M., G.W., A.J.K., G.W.S.); Gagnon Cardiovascular Institute, Morristown Medical Center, NJ (P.G.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Quebec, Canada (P.G.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
| | - Roxana Mehran
- From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (B.R., P.G., T.M., X.H., A.M., G.W., R.M., A.J.K., G.W.S.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center (J.D., A.M., G.W., A.J.K., G.W.S.); Gagnon Cardiovascular Institute, Morristown Medical Center, NJ (P.G.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Quebec, Canada (P.G.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
| | - Ajay J Kirtane
- From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (B.R., P.G., T.M., X.H., A.M., G.W., R.M., A.J.K., G.W.S.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center (J.D., A.M., G.W., A.J.K., G.W.S.); Gagnon Cardiovascular Institute, Morristown Medical Center, NJ (P.G.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Quebec, Canada (P.G.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
| | - Gregg W Stone
- From the Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (B.R., P.G., T.M., X.H., A.M., G.W., R.M., A.J.K., G.W.S.); Center for Interventional Vascular Therapy, Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center (J.D., A.M., G.W., A.J.K., G.W.S.); Gagnon Cardiovascular Institute, Morristown Medical Center, NJ (P.G.); Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Quebec, Canada (P.G.); Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany (B.W.); Els & Charles Bendheim Department of Cardiology, Shaare Zedek Medical Center, Jerusalem, Israel (G.W.); and The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M.)
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Comparison between the STENTYS self-apposing bare metal and paclitaxel-eluting coronary stents for the treatment of saphenous vein grafts (ADEPT trial). Neth Heart J 2017; 26:94-101. [PMID: 29255998 PMCID: PMC5783891 DOI: 10.1007/s12471-017-1066-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
AIMS To describe the safety and performance of STENTYS self-expandable bare metal stents (BMS) versus paclitaxel-eluting stents (PES) in saphenous vein grafts (SVGs). METHODS AND RESULTS A randomised controlled trial was performed in four hospitals in three European countries between December 2011 and December 2013. Patients with de novo lesions (>50% stenosis) in an SVG with a diameter between 2.5-6 mm were included. Primary endpoint was late lumen loss at 6 months. Secondary endpoints included procedural success and the occurrence of major adverse cardiac events (MACE) at 12 months. A total of 57 patients were randomised to STENTYS self-apposing BMS (n = 27) or PES (n = 30). Procedural success was obtained in 89.5%. No significant differences in late lumen loss were found between BMS and PES at 6 months (0.53 mm vs 0.47; p = 0.86). MACE rates at 12 months were comparable in both groups (BMS 22.2% vs. PES 26.7%; p = 0.70). CONCLUSIONS Treatment of SVGs with STENTYS self-expandable stents is safe and effective. No significant differences were found in late lumen loss and MACE between BMS and PES.
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Colombo A, Giannini F, Briguori C. Should We Still Have Bare-Metal Stents Available in Our Catheterization Laboratory? J Am Coll Cardiol 2017; 70:607-619. [PMID: 28750704 DOI: 10.1016/j.jacc.2017.05.057] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/21/2017] [Accepted: 05/26/2017] [Indexed: 12/17/2022]
Abstract
The introduction of bare-metal stents (BMS) has represented a major advancement over plain old balloon angioplasty in the management of coronary artery disease. However, the high rates of target lesion revascularization associated with use of BMS have led to the development of drug-eluting stents, which require prolonged dual antiplatelet therapy due to the increased risk of late and very late stent thrombosis. The improvements in newer-generation drug-eluting stents have translated into better safety and efficacy compared with earlier generation and BMS, thus allowing shorter dual antiplatelet therapy duration. Here, we aim to provide reasons as to why we still need BMS in our cardiac catheterization laboratory.
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Affiliation(s)
- Antonio Colombo
- Unit of Cardiovascular Interventions, Istituto Di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy.
| | - Francesco Giannini
- Unit of Cardiovascular Interventions, Istituto Di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy
| | - Carlo Briguori
- Unit of Cardiovascular Interventions, Istituto Di Ricovero e Cura a Carattere Scientifico San Raffaele Scientific Institute, Milan, Italy
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Lee M, Kong J. Current State of the Art in Approaches to Saphenous Vein Graft Interventions. Interv Cardiol 2017; 12:85-91. [PMID: 29588735 PMCID: PMC5808481 DOI: 10.15420/icr.2017:4:2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 06/20/2017] [Indexed: 12/13/2022] Open
Abstract
Saphenous vein grafts (SVGs), used during coronary artery bypass graft surgery for severe coronary artery disease, are prone to degeneration and occlusion, leading to poor long-term patency compared with arterial grafts. Interventions used to treat SVG disease are susceptible to high rates of periprocedural MI and no-reflow. To minimise complications seen with these interventions, proper stents, embolic protection devices (EPDs) and pharmacological selection are crucial. Regarding stent selection, evidence has demonstrated superiority of drug-eluting stents over bare-metal stents in SVG intervention. The ACCF/AHA/SCA American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Society for Cardiovascular Angiography and Interventions guidelines recommend the use of EPDs during SVG intervention to decrease the risk of periprocedural MI, distal embolisation and no-reflow. The optimal pharmacological treatment for slow or no-reflow remains unclear, but various vasodilators show promise.
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Brilakis ES, Banerjee S, Edson R, Shunk K, Goldman S, Holmes DR, Bhatt DL, Rao SV, Smith MW, Sather M, Colling C, Kar B, Nielsen L, Conner T, Wagner T, Rangan BV, Ventura B, Lu Y, Holodniy M, Shih MC. Rationale and design of the Drug-Eluting Stents vs Bare-Metal Stents in Saphenous Vein Graft Angioplasty (DIVA) Trial. Clin Cardiol 2017; 40:946-954. [PMID: 28841230 DOI: 10.1002/clc.22763] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 06/27/2017] [Indexed: 11/12/2022] Open
Abstract
VA Cooperative Studies Program #571 (DIVA) was designed to evaluate the efficacy of drug-eluting stents (DES) for reducing aortocoronary saphenous vein bypass graft (SVG) failure when compared with bare-metal stents (BMS) in participants undergoing stenting of de novo SVG lesions. Participants undergoing clinically indicated stenting of de novo SVG lesions were randomized in a 1:1 ratio to DES or BMS. Randomization was stratified by presence/absence of diabetes mellitus and the number of target SVG lesions (1 vs ≥2) within each participating site. At sites that did not routinely administer 12-months of dual antiplatelet therapy after SVG stenting participants without acute coronary syndromes received 1 month of open-label clopidogrel, followed by 11 months of clopidogrel for those assigned to DES and 11 months of placebo for those assigned to BMS. The primary endpoint was the 12-month incidence of target-vessel failure (defined as the composite of cardiac death, target-vessel myocardial infarction, or target-vessel revascularization). Secondary endpoints included the incidence of other clinical endpoints and the incremental cost-effectiveness of DES relative to BMS. Due to lower-than-anticipated target-vessel failure rates, target enrollment was increased from 519 to 762. The study had randomized 599 participants when recruitment ended in December 2015. The DIVA trial will provide clarity on the appropriate stent type for de novo SVG lesions.
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Affiliation(s)
- Emmanouil S Brilakis
- VA North Texas Health Care System, Dallas.,Minneapolis Heart Institute, Minneapolis, Minnesota.,University of Texas Southwestern Medical School, Dallas
| | - Subhash Banerjee
- VA North Texas Health Care System, Dallas.,University of Texas Southwestern Medical School, Dallas
| | - Robert Edson
- VA Cooperative Studies Program Coordinating Center, Mountain View, California
| | - Kendrick Shunk
- San Francisco VA Medical Center, San Francisco, California.,University of California, San Francisco
| | | | | | - Deepak L Bhatt
- VA Boston Healthcare System, Boston, Massachusetts.,Brigham and Women's Hospital Heart and Vascular Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Sunil V Rao
- Durham VA Medical Center, Durham, North Carolina.,Duke University, Durham, North Carolina
| | | | - Mike Sather
- VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico
| | - Cindy Colling
- VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico
| | - Biswajit Kar
- University of Texas Medical School, Houston.,Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Lori Nielsen
- VA Cooperative Studies Program Coordinating Center, Mountain View, California
| | - Todd Conner
- VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico
| | - Todd Wagner
- VA Health Economics Resource Center, Menlo Park, California.,Stanford University, Department of Surgery, Palo Alto, California
| | | | - Beverly Ventura
- VA Cooperative Studies Program Coordinating Center, Mountain View, California
| | - Ying Lu
- VA Cooperative Studies Program Coordinating Center, Mountain View, California.,Stanford University, Department of Biomedical Data Science, Palo Alto, California
| | - Mark Holodniy
- VA Cooperative Studies Program Coordinating Center, Mountain View, California.,Stanford University, Department of Medicine, Palo Alto, California
| | - Mei-Chiung Shih
- VA Cooperative Studies Program Coordinating Center, Mountain View, California.,Stanford University, Department of Biomedical Data Science, Palo Alto, California
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McKavanagh P, Yanagawa B, Zawadowski G, Cheema A. Management and Prevention of Saphenous Vein Graft Failure: A Review. Cardiol Ther 2017; 6:203-223. [PMID: 28748523 PMCID: PMC5688971 DOI: 10.1007/s40119-017-0094-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Indexed: 12/16/2022] Open
Abstract
Coronary artery bypass grafting (CABG) remains a vital treatment for patients with multivessel coronary artery disease (CAD), especially diabetics. The long-term benefit of the internal thoracic artery graft is well established and remains the gold standard for revascularization of severe CAD. It is not always possible to achieve complete revascularization through arterial grafts, necessitating the use of saphenous vein grafts (SVG). Unfortunately, SVGs do not have the same longevity, and their failure is associated with significant adverse cardiac outcomes and mortality. This paper reviews the pathogenesis of SVG failure, highlighting the difference between early, intermediate, and late failure. It also addresses the different surgical techniques that affect the incidence of SVG failure, as well as the medical and percutaneous prevention and treatment options in contemporary practice.
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Affiliation(s)
- Peter McKavanagh
- Terrence Donnelly Heart Center, Divisions of Cardiology and Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Canada.
| | - Bobby Yanagawa
- Terrence Donnelly Heart Center, Divisions of Cardiology and Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Canada
| | - George Zawadowski
- Terrence Donnelly Heart Center, Divisions of Cardiology and Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Canada
| | - Asim Cheema
- Terrence Donnelly Heart Center, Divisions of Cardiology and Cardiac Surgery, St Michael's Hospital, University of Toronto, Toronto, Canada
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Iqbal J, Kwok CS, Kontopantelis E, de Belder MA, Ludman PF, Large A, Butler R, Gamal A, Kinnaird T, Zaman A, Mamas MA. Choice of Stent for Percutaneous Coronary Intervention of Saphenous Vein Grafts. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.116.004457. [DOI: 10.1161/circinterventions.116.004457] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 03/03/2017] [Indexed: 11/16/2022]
Abstract
Background—
There are limited data on comparison of contemporary drug-eluting stent (DES) platforms, previous generation DES, and bare-metal stents (BMS) for percutaneous coronary intervention in saphenous vein grafts (SVG). We aimed to assess clinical outcomes following percutaneous coronary intervention to SVG in patients receiving bare-metal stents (BMS), first-generation DES, and newer generation DES in a large unselected national data set from the BCIS (British Cardiovascular Intervention Society).
Methods and Results—
Patients undergoing percutaneous coronary intervention to SVG in the United Kingdom from January 2006 to December 2013 were divided into 3 groups according to stent use: BMS, first-generation DES, and newer generation DES group. Study outcomes included in-hospital major adverse cardiovascular events, 30-day mortality, and 1-year mortality. Patients (n=15 003) underwent percutaneous coronary intervention to SVG in England and Wales during the study period. Of these, 38% received BMS, 15% received first-generation DES, and 47% received second-generation DES. The rates of in-hospital major adverse cardiovascular events were significantly lower in patients treated with second-generation DES (odds ratio, 0.51; 95% confidence interval, 0.38–0.68;
P
<0.001), but not with first-generation DES, compared with BMS-treated patients. Similarly, 30-day mortality (odds ratio, 0.43; 95% confidence interval, 0.32–0.59;
P
<0.001) and 1-year mortality (odds ratio, 0.60; 95% confidence interval, 0.51–0.71;
P
<0.001) were lower in patients treated with second-generation DES, but not with first-generation DES, compared with the patients treated with BMS.
Conclusions—
Patients receiving second-generation DES for the treatment SVG disease have lower rates of in-hospital major adverse cardiovascular events, 30-day mortality, and 1-year mortality, compared with those receiving BMS.
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Affiliation(s)
- Javaid Iqbal
- From the South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, United Kingdom (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); University Hospital North Staffordshire, United Kingdom (C.S.K., A.L., R.B., M.A.M.); Institute of Population Health (E.K.) and Farr Institute (M.A.M.), University of Manchester, United Kingdom; The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); Department of
| | - Chun Shing Kwok
- From the South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, United Kingdom (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); University Hospital North Staffordshire, United Kingdom (C.S.K., A.L., R.B., M.A.M.); Institute of Population Health (E.K.) and Farr Institute (M.A.M.), University of Manchester, United Kingdom; The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); Department of
| | - Evangelos Kontopantelis
- From the South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, United Kingdom (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); University Hospital North Staffordshire, United Kingdom (C.S.K., A.L., R.B., M.A.M.); Institute of Population Health (E.K.) and Farr Institute (M.A.M.), University of Manchester, United Kingdom; The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); Department of
| | - Mark A. de Belder
- From the South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, United Kingdom (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); University Hospital North Staffordshire, United Kingdom (C.S.K., A.L., R.B., M.A.M.); Institute of Population Health (E.K.) and Farr Institute (M.A.M.), University of Manchester, United Kingdom; The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); Department of
| | - Peter F. Ludman
- From the South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, United Kingdom (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); University Hospital North Staffordshire, United Kingdom (C.S.K., A.L., R.B., M.A.M.); Institute of Population Health (E.K.) and Farr Institute (M.A.M.), University of Manchester, United Kingdom; The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); Department of
| | - Adrian Large
- From the South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, United Kingdom (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); University Hospital North Staffordshire, United Kingdom (C.S.K., A.L., R.B., M.A.M.); Institute of Population Health (E.K.) and Farr Institute (M.A.M.), University of Manchester, United Kingdom; The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); Department of
| | - Rob Butler
- From the South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, United Kingdom (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); University Hospital North Staffordshire, United Kingdom (C.S.K., A.L., R.B., M.A.M.); Institute of Population Health (E.K.) and Farr Institute (M.A.M.), University of Manchester, United Kingdom; The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); Department of
| | - Amr Gamal
- From the South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, United Kingdom (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); University Hospital North Staffordshire, United Kingdom (C.S.K., A.L., R.B., M.A.M.); Institute of Population Health (E.K.) and Farr Institute (M.A.M.), University of Manchester, United Kingdom; The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); Department of
| | - Tim Kinnaird
- From the South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, United Kingdom (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); University Hospital North Staffordshire, United Kingdom (C.S.K., A.L., R.B., M.A.M.); Institute of Population Health (E.K.) and Farr Institute (M.A.M.), University of Manchester, United Kingdom; The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); Department of
| | - Azfar Zaman
- From the South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, United Kingdom (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); University Hospital North Staffordshire, United Kingdom (C.S.K., A.L., R.B., M.A.M.); Institute of Population Health (E.K.) and Farr Institute (M.A.M.), University of Manchester, United Kingdom; The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); Department of
| | - Mamas A. Mamas
- From the South Yorkshire Cardiothoracic Centre, Northern General Hospital, Sheffield, United Kingdom (J.I.); Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., M.A.M.); University Hospital North Staffordshire, United Kingdom (C.S.K., A.L., R.B., M.A.M.); Institute of Population Health (E.K.) and Farr Institute (M.A.M.), University of Manchester, United Kingdom; The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); Department of
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Superior long term outcome associated with native vessel versus graft vessel PCI following secondary PCI in patients with prior CABG. Int J Cardiol 2017; 228:563-569. [DOI: 10.1016/j.ijcard.2016.11.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 08/10/2016] [Accepted: 11/05/2016] [Indexed: 12/21/2022]
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Bavishi C, Chatterjee S, Stone GW. Does Current Evidence Favor Drug-Eluting Stents Over Bare-Metal Stents for Saphenous Venous Graft Interventions? JACC Cardiovasc Interv 2016; 9:2456-2458. [DOI: 10.1016/j.jcin.2016.09.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 09/22/2016] [Indexed: 11/25/2022]
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Rodés-Cabau J, Jolly SS, Cairns J, Mansour S, L’Allier PL, Teefy PJ, Graham JJ, Le May MR, Cantor WJ, Wood D, Balasubramanian K, DeLarochellière R, Dzavik V. Sealing Intermediate Nonobstructive Coronary Saphenous Vein Graft Lesions With Drug-Eluting Stents as a New Approach to Reducing Cardiac Events. Circ Cardiovasc Interv 2016; 9:CIRCINTERVENTIONS.116.004336. [DOI: 10.1161/circinterventions.116.004336] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 09/21/2016] [Indexed: 11/16/2022]
Abstract
Background—
The objective of this study was to assess the efficacy of sealing intermediate nonobstructive coronary saphenous vein graft (SVG) lesions with drug-eluting stents (DES; paclitaxel- or everolimus-eluting stents) for reducing major adverse cardiac events (MACE).
Methods and Results—
This was a randomized controlled multicenter clinical trial that enrolled patients with a previous coronary artery bypass graft who had developed at least 1 intermediate nonobstructive SVG lesion (30%–60% diameter stenosis by visual estimation). Patients were randomized (1:1) to DES implantation (SVG-DES) or medical treatment (SVG-MT) of the target SVG lesion. The primary efficacy outcome was the first occurrence of MACE defined as the composite of cardiac death, myocardial infarction, or coronary revascularization related to the target SVG during the duration of follow-up (minimum of 2 years). Secondary efficacy outcomes included MACE related to the target SVG lesion and overall MACE. A total of 125 patients (mean age 70±9 years, 87% men) were included, with a mean time from coronary artery bypass graft of 12±5 years. Sixty and 65 patients were allocated to the SVG-DES and SVG-MT groups, respectively. There were no events related to the target SVG at 30 days. After a median follow-up of 3.4 (interquartile range: 2.8–3.9) years, the MACE rate related to the target SVG was not significantly different in the 2 groups (SVG-DES: 15.0%, SVG-MT: 20.0%; hazard ratio, 0.65; 95% confidence interval, 0.23–1.53;
P
=0.33). There were no significant differences between groups in MACE related to the target SVG lesion (SVG-DES: 10.0%, SVG-MT: 16.9%; hazard ratio, 0.53; 95% confidence interval, 0.20–1.43;
P
=0.21) or global MACE (SVG-DES: 36.7%, SVG-MT: 44.6%; hazard ratio, 0.73; 95% confidence interval, 0.42–1.27;
P
=0.26).
Conclusions—
Sealing intermediate nonobstructive SVG lesions with DES was safe but was not associated with a significant reduction of cardiac events at 3-year follow-up.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01223443.
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Affiliation(s)
- Josep Rodés-Cabau
- From the Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (J.R.-C., R.D.L.); Population Health Research Institute, Hamilton General Hospital, McMaster University, Ontario, Canada (S.S.J.); Department of Medicine, Vancouver General Hospital, British Columbia, Canada (J.C., D.W.); Cardiology Department, Centre Hospitalier Universitaire de Montreal, Quebec, Canada (S.M.); Department of Medicine, Montreal Heart Institute, Quebec, Canada (P.L.L.)
| | - Sanjit S. Jolly
- From the Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (J.R.-C., R.D.L.); Population Health Research Institute, Hamilton General Hospital, McMaster University, Ontario, Canada (S.S.J.); Department of Medicine, Vancouver General Hospital, British Columbia, Canada (J.C., D.W.); Cardiology Department, Centre Hospitalier Universitaire de Montreal, Quebec, Canada (S.M.); Department of Medicine, Montreal Heart Institute, Quebec, Canada (P.L.L.)
| | - John Cairns
- From the Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (J.R.-C., R.D.L.); Population Health Research Institute, Hamilton General Hospital, McMaster University, Ontario, Canada (S.S.J.); Department of Medicine, Vancouver General Hospital, British Columbia, Canada (J.C., D.W.); Cardiology Department, Centre Hospitalier Universitaire de Montreal, Quebec, Canada (S.M.); Department of Medicine, Montreal Heart Institute, Quebec, Canada (P.L.L.)
| | - Samer Mansour
- From the Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (J.R.-C., R.D.L.); Population Health Research Institute, Hamilton General Hospital, McMaster University, Ontario, Canada (S.S.J.); Department of Medicine, Vancouver General Hospital, British Columbia, Canada (J.C., D.W.); Cardiology Department, Centre Hospitalier Universitaire de Montreal, Quebec, Canada (S.M.); Department of Medicine, Montreal Heart Institute, Quebec, Canada (P.L.L.)
| | - Philippe L. L’Allier
- From the Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (J.R.-C., R.D.L.); Population Health Research Institute, Hamilton General Hospital, McMaster University, Ontario, Canada (S.S.J.); Department of Medicine, Vancouver General Hospital, British Columbia, Canada (J.C., D.W.); Cardiology Department, Centre Hospitalier Universitaire de Montreal, Quebec, Canada (S.M.); Department of Medicine, Montreal Heart Institute, Quebec, Canada (P.L.L.)
| | - Patrick J. Teefy
- From the Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (J.R.-C., R.D.L.); Population Health Research Institute, Hamilton General Hospital, McMaster University, Ontario, Canada (S.S.J.); Department of Medicine, Vancouver General Hospital, British Columbia, Canada (J.C., D.W.); Cardiology Department, Centre Hospitalier Universitaire de Montreal, Quebec, Canada (S.M.); Department of Medicine, Montreal Heart Institute, Quebec, Canada (P.L.L.)
| | - John J. Graham
- From the Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (J.R.-C., R.D.L.); Population Health Research Institute, Hamilton General Hospital, McMaster University, Ontario, Canada (S.S.J.); Department of Medicine, Vancouver General Hospital, British Columbia, Canada (J.C., D.W.); Cardiology Department, Centre Hospitalier Universitaire de Montreal, Quebec, Canada (S.M.); Department of Medicine, Montreal Heart Institute, Quebec, Canada (P.L.L.)
| | - Michel R. Le May
- From the Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (J.R.-C., R.D.L.); Population Health Research Institute, Hamilton General Hospital, McMaster University, Ontario, Canada (S.S.J.); Department of Medicine, Vancouver General Hospital, British Columbia, Canada (J.C., D.W.); Cardiology Department, Centre Hospitalier Universitaire de Montreal, Quebec, Canada (S.M.); Department of Medicine, Montreal Heart Institute, Quebec, Canada (P.L.L.)
| | - Warren J. Cantor
- From the Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (J.R.-C., R.D.L.); Population Health Research Institute, Hamilton General Hospital, McMaster University, Ontario, Canada (S.S.J.); Department of Medicine, Vancouver General Hospital, British Columbia, Canada (J.C., D.W.); Cardiology Department, Centre Hospitalier Universitaire de Montreal, Quebec, Canada (S.M.); Department of Medicine, Montreal Heart Institute, Quebec, Canada (P.L.L.)
| | - David Wood
- From the Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (J.R.-C., R.D.L.); Population Health Research Institute, Hamilton General Hospital, McMaster University, Ontario, Canada (S.S.J.); Department of Medicine, Vancouver General Hospital, British Columbia, Canada (J.C., D.W.); Cardiology Department, Centre Hospitalier Universitaire de Montreal, Quebec, Canada (S.M.); Department of Medicine, Montreal Heart Institute, Quebec, Canada (P.L.L.)
| | - Kumar Balasubramanian
- From the Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (J.R.-C., R.D.L.); Population Health Research Institute, Hamilton General Hospital, McMaster University, Ontario, Canada (S.S.J.); Department of Medicine, Vancouver General Hospital, British Columbia, Canada (J.C., D.W.); Cardiology Department, Centre Hospitalier Universitaire de Montreal, Quebec, Canada (S.M.); Department of Medicine, Montreal Heart Institute, Quebec, Canada (P.L.L.)
| | - Robert DeLarochellière
- From the Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (J.R.-C., R.D.L.); Population Health Research Institute, Hamilton General Hospital, McMaster University, Ontario, Canada (S.S.J.); Department of Medicine, Vancouver General Hospital, British Columbia, Canada (J.C., D.W.); Cardiology Department, Centre Hospitalier Universitaire de Montreal, Quebec, Canada (S.M.); Department of Medicine, Montreal Heart Institute, Quebec, Canada (P.L.L.)
| | - Vlad Dzavik
- From the Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (J.R.-C., R.D.L.); Population Health Research Institute, Hamilton General Hospital, McMaster University, Ontario, Canada (S.S.J.); Department of Medicine, Vancouver General Hospital, British Columbia, Canada (J.C., D.W.); Cardiology Department, Centre Hospitalier Universitaire de Montreal, Quebec, Canada (S.M.); Department of Medicine, Montreal Heart Institute, Quebec, Canada (P.L.L.)
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Gao J, Ren M, Liu Y, Gao M, Sun B. Drug-eluting versus bare metal stent in treatment of patients with saphenous vein graft disease: A meta-analysis of randomized controlled trials. Int J Cardiol 2016; 222:95-100. [PMID: 27479550 DOI: 10.1016/j.ijcard.2016.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/29/2016] [Accepted: 07/02/2016] [Indexed: 10/21/2022]
Abstract
Drug-eluting stent (DES) and bare metal stent (BMS) are effective treatments for preventing vascular disease, but whether using DES is associated with positive clinical outcomes compared with BMS in patients with saphenous vein graft disease (SVGD) has not been established. Three electronic databases including PubMed, EmBase, and the Cochrane Central Register of Controlled Trials were searched to identify potentially includible studies. We did a random-effects meta-analysis of randomized controlled trials (RCTs) to obtain summary effect estimates for the clinical outcomes with the use of relative risk calculated from the raw data of individual trial. Among 812 patients from 4 RCTs, DES was associated with lower risk of short-term major cardiovascular events (MACEs) when compared with BMS, whereas no significant effect on the risk of long-term MACEs. Furthermore, there was no significant difference between DES and BMS for short-term myocardial infarction (MI) and long-term MI. Similarly, DES was not associated with risk of short- and long-term mortality risk as compared with BMS. In addition, DES has no significant effect on the risk of cardiac death and stent thrombosis. Finally, DES therapy significantly reduced the risk of TLR, TVF, and TVR. SVGD patients received DES can minimize the risk of short-term MACEs, TLR, TVF, and TVR when compared with BMS. However, it does not effect on the incidence of long-term MACEs, MI, mortality, cardiac death, and stent thrombosis.
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Affiliation(s)
- Jing Gao
- Cardiovascular Institute, Tianjin Chest Hospital, Tianjin 300222, China; Department of Cardiology, Tianjin Chest Hospital, Tianjin 300222, China
| | - Min Ren
- Cardiovascular Institute, Tianjin Chest Hospital, Tianjin 300222, China; Department of Cardiology, Tianjin Chest Hospital, Tianjin 300222, China; Graduate School of Medicine,Tianjin Medical University, Tianjin 300070, China
| | - Yin Liu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin 300222, China.
| | - Mingdong Gao
- Department of Cardiology, Tianjin Chest Hospital, Tianjin 300222, China
| | - Bo Sun
- Department of Cardiology, Tianjin Chest Hospital, Tianjin 300222, China; Graduate School of Medicine,Tianjin Medical University, Tianjin 300070, China
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Percutaneous Coronary Intervention in Native Coronary Arteries Versus Bypass Grafts in Patients With Prior Coronary Artery Bypass Graft Surgery: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program. JACC Cardiovasc Interv 2016; 9:884-93. [PMID: 27085582 DOI: 10.1016/j.jcin.2016.01.034] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 01/14/2016] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The aim of this study was to examine the frequency, associations, and outcomes of native coronary artery versus bypass graft percutaneous coronary intervention (PCI) in patients with prior coronary artery bypass grafting (CABG) in the Veterans Affairs (VA) integrated health care system. BACKGROUND Patients with prior CABG surgery often undergo PCI, but the association between PCI target vessel and short- and long-term outcomes has received limited study. METHODS A national cohort of 11,118 veterans with prior CABG who underwent PCI between October 2005 and September 2013 at 67 VA hospitals was examined, and the outcomes of patients who underwent native coronary versus bypass graft PCI were compared. Logistic regression with generalized estimating equations was used to adjust for correlation between patients within hospitals. Cox regressions were modeled for each outcome to determine the variables with significant hazard ratios (HRs). RESULTS During the study period, patients with prior CABG represented 18.5% of all patients undergoing PCI (11,118 of 60,171). The PCI target vessel was a native coronary artery in 73.4% and a bypass graft in 26.6%: 25.0% in a saphenous vein graft and 1.5% in an arterial graft. Compared with patients undergoing native coronary artery PCI, those undergoing bypass graft PCI had higher risk characteristics and more procedure-related complications. During a median follow-up period of 3.11 years, bypass graft PCI was associated with significantly higher mortality (adjusted HR: 1.30; 95% confidence interval: 1.18 to 1.42), myocardial infarction (adjusted HR: 1.61; 95% confidence interval: 1.43 to 1.82), and repeat revascularization (adjusted HR: 1.60; 95% confidence interval: 1.50 to 1.71). CONCLUSIONS In a national cohort of veterans, almost three-quarters of PCIs performed in patients with prior CABG involved native coronary artery lesions. Compared with native coronary PCI, bypass graft PCI was significantly associated with higher incidence of short- and long-term major adverse events, including more than double the rate of in-hospital mortality.
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Shi HT, Chu HX, Gu W, Cai XY, Guo JJ, Ding ZG, Gao W, Ma LL, Zhu JB, Liu HB, Huang ZY, Wang QB, Ge JB, Wen SJ. Second-generation versus first-generation drug-eluting stents in saphenous vein graftdisease: A meta-analysis of randomized controlled trials. Int J Cardiol 2016; 214:393-7. [PMID: 27085653 DOI: 10.1016/j.ijcard.2016.03.228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 03/27/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Second-generation drug-eluting stents (DESs) have become increasingly popular devices for patients with saphenous vein graft (SVG) disease. Second-generation DESs were designed to have more safety and efficacy than first-generation DES, but clinical outcomes in SVG disease remain conflicting. METHODS AND RESULTS Randomized controlled trials (RCTs) were identified when comparing second- versus first-generation DESs in SVG disease. The main endpoint was all-cause death. The time of follow-up was at least 30days. The secondary endpoints were major adverse cardiovascular events (MACEs), target vessel revascularization (TVR), target lesion revascularization (TLR), myocardial infarction (MI), and stent thrombosis. These endpoints were assessed at 30days, 12months and 24months. Four RCTs with 1077 SVG patients undergoing the implantation of DES were collected in the current meta-analysis. As a result, second-generation DES-treated patients had the significantly lower MACE rates at 12months (P=0.03; OR: 0.69, 95% CI: 0.49,0.97). No differences in two groups were seen in all-cause death, MI, TVR, stent thrombosis and TLR. CONCLUSIONS Our limited evidence indicated that, second-generation DES in SVG patients, compared with first-generation DES, offered similar levels of safety, but were more effective than the former one.
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Affiliation(s)
- Hong-Tao Shi
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 200032 Shanghai, PR China
| | - Hong-Xia Chu
- Department of Cardiology, Yuhuangding Hospital, Qingdao Medical College, Qingdao University, 264000 Yantai, Shandong Province, PR China
| | - Wei Gu
- Department of Hypertension Research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, 100029 Beijing, PR China
| | - Xin-Yong Cai
- Department of Cardiology, Jiangxi Provincial People's Hospital, 330006 Nanchang, Jiangxi Province, PR China
| | - Jun-Jie Guo
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 200032 Shanghai, PR China; Department of Cardiology, the Affiliated Hospital of Qingdao University, 266003 Qingdao, Shandong Province, PR China
| | - Zhao-Gang Ding
- Department of Cardiology, Rizhao City Hospital of Traditional Chinese Medicine, 276800 Rizhao, Shandong Province, PR China
| | - Wei Gao
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 200032 Shanghai, PR China
| | - Lei-Lei Ma
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 200032 Shanghai, PR China
| | - Jian-Bing Zhu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 200032 Shanghai, PR China
| | - Hai-Bo Liu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 200032 Shanghai, PR China
| | - Zhe-Yong Huang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 200032 Shanghai, PR China
| | - Qi-Bing Wang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 200032 Shanghai, PR China
| | - Jun-Bo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 200032 Shanghai, PR China.
| | - Shao-Jun Wen
- Department of Hypertension Research, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, 100029 Beijing, PR China.
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Lee MS, Manthripragada G. Saphenous Vein Graft Interventions. Interv Cardiol Clin 2016; 5:135-141. [PMID: 28582199 DOI: 10.1016/j.iccl.2015.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Saphenous vein graft interventions compose a small but important subset of percutaneous coronary revascularization. Because of their unique biology, percutaneous angioplasty and stenting require tailored patient and lesion selection and modification of intervention technique to optimize outcomes. The use of embolic protection and appropriate adjunctive pharmacology can help minimize periprocedural complications, such as the no-reflow phenomenon. Recommendations for best practice in saphenous vein graft interventions continue to evolve with emerging research and therapy.
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Affiliation(s)
- Michael S Lee
- Cardiology Division, Department of Medicine, 100 Medical Plaza, Suite 630, Los Angeles, CA 90095, USA.
| | - Gopi Manthripragada
- Cardiology Division, Department of Medicine, 100 Medical Plaza, Suite 630, Los Angeles, CA 90095, USA
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44
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Comparison of clinical outcomes in patients presenting with an acute coronary syndrome due to stent thrombosis or saphenous vein graft occlusion and undergoing percutaneous coronary intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2015; 16:441-6. [DOI: 10.1016/j.carrev.2015.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 10/20/2015] [Indexed: 12/15/2022]
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45
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Mazhar J, Rehmani A, Rahman M, Farshid A. Clinical outcome of 2nd generation drug-eluting stents versus bare-metal stents in percutaneous intervention on vein grafts. Interv Cardiol 2015. [DOI: 10.2217/ica.15.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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46
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Yıldız A, Yıldız C. Long-term clinical results of saphenous vein bypass graft lesions treated with bare-metal stents and drug eluting stents. INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2015. [DOI: 10.1016/j.ijcac.2015.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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47
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Pokala NR, Menon RV, Patel SM, Christopoulos G, Christakopoulos GE, Kotsia AP, Rangan BV, Roesle M, Abdullah S, Grodin J, Kumbhani DJ, Hastings J, Banerjee S, Brilakis ES. Long-term outcomes with first- vs. second-generation drug-eluting stents in saphenous vein graft lesions. Catheter Cardiovasc Interv 2015; 87:34-40. [DOI: 10.1002/ccd.25982] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 04/04/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Nagendra R. Pokala
- Department of Cardiovascular Diseases; VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Rohan V. Menon
- Department of Cardiovascular Diseases; VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Siddharth M. Patel
- Department of Cardiovascular Diseases; VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - George Christopoulos
- Department of Cardiovascular Diseases; VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Georgios E. Christakopoulos
- Department of Cardiovascular Diseases; VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Anna P. Kotsia
- Department of Cardiovascular Diseases; VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Bavana V. Rangan
- Department of Cardiovascular Diseases; VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Michele Roesle
- Department of Cardiovascular Diseases; VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Shuaib Abdullah
- Department of Cardiovascular Diseases; VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Jerrold Grodin
- Department of Cardiovascular Diseases; VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Dharam J. Kumbhani
- Department of Cardiovascular Diseases; VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Jeffrey Hastings
- Department of Cardiovascular Diseases; VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Subhash Banerjee
- Department of Cardiovascular Diseases; VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
| | - Emmanouil S. Brilakis
- Department of Cardiovascular Diseases; VA North Texas Healthcare System and UT Southwestern Medical Center; Dallas Texas
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48
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Sosa A, Chao H, Guerra A, Han H, Christopoulos G, Christakopoulos GE, Tarar MNJ, de Lemos JA, Obel O, Addo T, Roesle M, Haagen D, Rangan BV, Banerjee S, Brilakis ES. Paclitaxel-eluting vs. bare metal stent implantation in saphenous vein graft lesions: Very long-term follow-up of the SOS (Stenting of Saphenous vein grafts) trial. Int J Cardiol 2015; 186:261-3. [PMID: 25828130 DOI: 10.1016/j.ijcard.2015.03.267] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 03/19/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Alan Sosa
- VA North Texas Health Care System, University of Texas Southwestern Medical School, Dallas, TX, United States
| | - Howard Chao
- VA North Texas Health Care System, University of Texas Southwestern Medical School, Dallas, TX, United States
| | - Andres Guerra
- VA North Texas Health Care System, University of Texas Southwestern Medical School, Dallas, TX, United States
| | - Henry Han
- VA North Texas Health Care System, University of Texas Southwestern Medical School, Dallas, TX, United States
| | - Georgios Christopoulos
- VA North Texas Health Care System, University of Texas Southwestern Medical School, Dallas, TX, United States
| | - Georgios E Christakopoulos
- VA North Texas Health Care System, University of Texas Southwestern Medical School, Dallas, TX, United States
| | - Muhammad Nauman J Tarar
- VA North Texas Health Care System, University of Texas Southwestern Medical School, Dallas, TX, United States
| | - James A de Lemos
- VA North Texas Health Care System, University of Texas Southwestern Medical School, Dallas, TX, United States
| | - Owen Obel
- VA North Texas Health Care System, University of Texas Southwestern Medical School, Dallas, TX, United States
| | - Tayo Addo
- VA North Texas Health Care System, University of Texas Southwestern Medical School, Dallas, TX, United States
| | - Michele Roesle
- VA North Texas Health Care System, University of Texas Southwestern Medical School, Dallas, TX, United States
| | - Donald Haagen
- VA North Texas Health Care System, University of Texas Southwestern Medical School, Dallas, TX, United States
| | - Bavana V Rangan
- VA North Texas Health Care System, University of Texas Southwestern Medical School, Dallas, TX, United States
| | - Subhash Banerjee
- VA North Texas Health Care System, University of Texas Southwestern Medical School, Dallas, TX, United States
| | - Emmanouil S Brilakis
- VA North Texas Health Care System, University of Texas Southwestern Medical School, Dallas, TX, United States.
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49
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Liu Y, Zhou X, Jiang H, Gao M, Wang L, Shi Y, Gao J. Percutaneous coronary intervention strategies and prognosis for graft lesions following coronary artery bypass grafting. Exp Ther Med 2015; 9:1656-1664. [PMID: 26136874 DOI: 10.3892/etm.2015.2366] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 01/09/2015] [Indexed: 11/06/2022] Open
Abstract
The purpose of this study was to compare the prognosis of graft-percutaneous coronary intervention (PCI) and native vessel (NV)-PCI, drug-eluting stents (DESs) and bare-metal stents (BMSs) for the treatment of graft lesions following coronary artery bypass grafting (CABG), and to determine the risk factors for major adverse cardiac events (MACEs). A total of 289 patients who underwent PCI following CABG between August 2005 and March 2010 were retrospectively analyzed. The effects on survival were compared among patients who underwent NV- and graft-PCI, and DES and BMS implantation. Additionally, the risk factors for MACEs following PCI for graft lesions were analyzed. The findings showed that MACE-free and revascularization-free survival rates were significantly higher in the NV-PCI group compared with those in the graft-PCI group. There were 63 cases (29.0%) of MACEs in the DES group and 25 cases (52.1%) in the BMS group. In patients undergoing NV-PCI, the DES group had significantly fewer MACEs and less target vessel revascularization (TVR) than the BMS group. In patients undergoing graft-PCI, the DES group showed a tendency for fewer MACEs and a lower incidence of cardiac mortality, myocardial infarction and TVR compared with the BMS group. Diabetes, an age of >70 years and graft-PCI were independent risk factors for MACEs in patients post-PCI. It is concluded that NV-PCI has superior long-term outcomes compared with graft-PCI, and should therefore be considered as the first-line treatment for graft disease following CABG. Despite this, graft-PCI remains a viable option. DESs are the first choice for graft-PCI due to their safety and efficacy and their association with reduced mortality and MACE rate. Diabetes, older age and graft-PCI are independent risk factors for MACEs in patients post-CABG who are undergoing revascularization.
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Affiliation(s)
- Yin Liu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin 300051, P.R. China
| | - Xiujun Zhou
- Department of Cardiology, Tianjin Chest Hospital, Tianjin 300051, P.R. China
| | - Hua Jiang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin 300051, P.R. China
| | - Mingdong Gao
- Department of Cardiology, Tianjin Chest Hospital, Tianjin 300051, P.R. China
| | - Lin Wang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin 300051, P.R. China
| | - Yutian Shi
- Department of Cardiology, Tianjin Chest Hospital, Tianjin 300051, P.R. China
| | - Jing Gao
- Cardiovascular Institute, Department of Cardiology, Tianjin Chest Hospital, Tianjin 300051, P.R. China
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50
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Coronary Artery Bypass Surgery and Percutaneous Coronary Revascularization: Impact on Morbidity and Mortality in Patients with Coronary Artery Disease. Coron Artery Dis 2015. [DOI: 10.1007/978-1-4471-2828-1_26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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