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Percutaneous coronary intervention of totally occluded coronary venous bypass grafts:An exercise in futility?

world Journal of Cardiology 2021年第9期13卷 493-502页

作者： evan w nardone Brandon M Madsen Melissa M McCarey David L Fischman Nicholas J Ruggiero Paul walinsky Alec Vishnevsky Michael P Savage Department of Medicine Thomas Jefferson UniversityPhiladelphiaPA 19107United States Department of Anesthesiology Medstar Georgetown University HospitalWashingtonDC 20007United States Jefferson Clinical Research Institue Thomas Jefferson UniversityPhiladelphiaPA 19107United States

BACKGROUND Percutaneous coronary intervention(PCI)of diseased saphenous vein grafts(SVG)continues to pose a clinical *** PCI guidelines give a class III recommendation against performing PCI on chronically occluded ***,contemporary outcomes after SVG intervention have incrementally improved with distal protection devices,intracoronary vasodilators,drug-eluting stents,and prolonged dual antiplatelet *** To reassess the procedural and long-term outcomes of PCI for totally occluded SVG with contemporary *** This was a retrospective observational study conducted at a single university *** study population consisted of 35 consecutive patients undergoing PCI of totally occluded ***-procedure dual antiplatelet therapy was continued for a minimum of one year and aspirin was continued *** outcomes were assessed at a mean follow-up of 1221±1038 *** primary outcome was freedom from a major adverse cardiac event(MACE)defined as the occurrence of any of the following:death,myocardial infarction,stroke,repeat bypass surgery,repeat PCI,or graft *** The study group included 29 men and 6 women with a mean age of 69±12 *** was present in 14(40%)*** patients had Canadian Heart Classification class III or IV *** presentation was an acute coronary syndrome in 34(97%)*** SVG age was 12±5 *** duration of occlusion was acute(24 h to 30 d)in 26%,and late(>30 d)in 40%.PCI was initially successful in 29/35 SVG occlusions(83%).Total stent length was 52±35 *** complications of distal embolization or no-reflow occurred in 6(17%)*** longer term follow-up,MACE-free survival was only 30%at 3 years and 17%at 5 *** PCI of totally occluded SVG can be performed with a high procedural success ***,its clinical utility remains limited by poor follow-up outcomes.

关键词： Coronary artery bypass grafting Coronary stents Chronic total occlusion Percutaneous coronary intervention Restenosis Saphenous vein grafts

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