TY - JOUR
T1 - Clinical Presentation and Angiographic Characteristics of Saphenous Vein Graft Failure After Stenting. Insights From the SOS (Stenting Of Saphenous Vein Grafts) Trial
AU - Lichtenwalter, Christopher
AU - de Lemos, James A
AU - Roesle, Michele
AU - Obel, Owen
AU - Holper, Elizabeth M.
AU - Haagen, Donald
AU - Saeed, Bilal
AU - Iturbe, Jose Miguel
AU - Shunk, Kendrick
AU - Bissett, Joseph K.
AU - Sachdeva, Rajesh
AU - Voudris, Vassilios V.
AU - Karyofillis, Panagiotis
AU - Kar, Biswajit
AU - Rossen, James
AU - Fasseas, Panayotis
AU - Berger, Peter
AU - Banerjee, Subhash
AU - Brilakis, Emmanouil S
N1 - Funding Information:
The study was presented at the SCAI's 2009 Annual Scientific Sessions in Las Vegas, Nevada. The SOS trial was funded by a Veteran Affairs VISN-17 Startup Award and by a Clark R. Gregg Grant of the Harris Methodist Foundation to Dr. Brilakis. Dr. de Lemos has received speaker honoraria from Bristol-Myers Squibb/Sanofi-Aventis and consulting income from Johnson and Johnson ($10,000). Dr. Banerjee has served on the Speakers' Bureau for St. Jude Medical Center, Medtronic Corp., and Johnson & Johnson, and has received a research grant from Boston Scientific. Dr. Brilakis has received speaker honoraria from St. Jude.
PY - 2009/9
Y1 - 2009/9
N2 - Objectives: We sought to compare the clinical presentation and angiographic patterns of saphenous vein graft (SVG) failure after stenting with a paclitaxel-eluting stent (PES) versus a similar bare-metal stent (BMS). Background: The mode of SVG failure after stenting has been poorly characterized. Methods: The SOS (Stenting Of Saphenous Vein Grafts) trial enrolled 80 patients with 112 lesions in 88 SVGs who were randomized to a BMS or PES. Angiographic follow-up at 12 months was available in 83% of the patients. Results: Binary angiographic restenosis occurred in 51% (24 of 47) of BMS-treated lesions versus 9% (4 of 43) of PES-treated lesions (p < 0.0001). Graft occlusion occurred in 9 of the 21 SVGs (43%) that failed in the BMS group and in 2 of 4 SVGs (50%) that failed in the PES group. SVG failure after stenting presented as an acute coronary syndrome in 10 of the 24 patients (42%) (7 of those 10 patients presented with non-ST-segment elevation acute myocardial infarction), stable angina in 9 (37%) patients, and without symptoms in 5 (21%) patients. Of the 19 patients (with 20 grafts) who developed symptomatic graft failure, repeat SVG revascularization was successfully performed in all 13 (100%) subtotally obstructed SVGs but was attempted (and successful) in only 1 of 7 (14%) occluded SVGs. Revascularization of a native coronary artery was performed in an additional 4 of 7 (57%) symptomatic patients with an occluded SVG. Conclusions: SVG failure after stenting often presents as acute myocardial infarction and with SVG occlusion. Compared with BMS, PES reduce SVG failure.
AB - Objectives: We sought to compare the clinical presentation and angiographic patterns of saphenous vein graft (SVG) failure after stenting with a paclitaxel-eluting stent (PES) versus a similar bare-metal stent (BMS). Background: The mode of SVG failure after stenting has been poorly characterized. Methods: The SOS (Stenting Of Saphenous Vein Grafts) trial enrolled 80 patients with 112 lesions in 88 SVGs who were randomized to a BMS or PES. Angiographic follow-up at 12 months was available in 83% of the patients. Results: Binary angiographic restenosis occurred in 51% (24 of 47) of BMS-treated lesions versus 9% (4 of 43) of PES-treated lesions (p < 0.0001). Graft occlusion occurred in 9 of the 21 SVGs (43%) that failed in the BMS group and in 2 of 4 SVGs (50%) that failed in the PES group. SVG failure after stenting presented as an acute coronary syndrome in 10 of the 24 patients (42%) (7 of those 10 patients presented with non-ST-segment elevation acute myocardial infarction), stable angina in 9 (37%) patients, and without symptoms in 5 (21%) patients. Of the 19 patients (with 20 grafts) who developed symptomatic graft failure, repeat SVG revascularization was successfully performed in all 13 (100%) subtotally obstructed SVGs but was attempted (and successful) in only 1 of 7 (14%) occluded SVGs. Revascularization of a native coronary artery was performed in an additional 4 of 7 (57%) symptomatic patients with an occluded SVG. Conclusions: SVG failure after stenting often presents as acute myocardial infarction and with SVG occlusion. Compared with BMS, PES reduce SVG failure.
KW - bare-metal stents
KW - coronary artery bypass graft surgery
KW - drug-eluting stents
KW - outcomes
KW - percutaneous coronary intervention
KW - saphenous vein grafts
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U2 - 10.1016/j.jcin.2009.06.014
DO - 10.1016/j.jcin.2009.06.014
M3 - Article
C2 - 19778774
AN - SCOPUS:70349224293
SN - 1936-8798
VL - 2
SP - 855
EP - 860
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 9
ER -