Objectives We sought to examine saphenous vein graft (SVG) lesions that fail within the first year after operation. Background Saphenous vein grafts remain patent for approximately 10 years; how ever, up to 15%to 20%o...Objectives We sought to examine saphenous vein graft (SVG) lesions that fail within the first year after operation. Background Saphenous vein grafts remain patent for approximately 10 years; how ever, up to 15%to 20%of SVGs become occluded within the first year. Methods We studied 100 patients who underwent percutaneous coronary intervention(PCI) for early (< 1 year post implantation) SVG failure lesions and compared them with a diabetes and hypercholesterolemia matched cohort of late SVG failures (>1 yea r). Coronary angiography and intravascular ultrasound images were analyzed. Resu lts The majority of patients in both groups were males who presented with unstab le angina; 36%were diabetic. Graft ages were 6.0 ±2.9 months and 105.4 ±50.8 months, respectively. The early SVG failure lesion location was more often ostia l or proximal (62%vs. 42%, respectively). Early SVG failures were angiographic ally smaller than late failures (reference: 2.47 ±0.86 mm vs. 3.26 ±0.83 mm, p < 0.001) but had similar lesion lengths. Intravascular ultrasound showed that ea rly failure lesions had smaller proximal and distal reference lumen areas (7.3± 6.8mm2 vs. 10.6±3.8mm2, p=0.026) and greater reference plaque burden than late failures (52.3%vs. 36.1%, p < 0.001). After PCI, 20.6%of early and 30.6%of l ate failure lesions had creatine kinase myocardial band(CK MB) greater than tw ice normal. Conclusions Early SVG failure is mostly proximal or ostial, lesions appear focal, and early SVGs appear smaller than late SVGs. Intravascular ultras ound shows significant reference segment plaque burden, suggesting more severe, diffuse SVG disease.展开更多
文摘Objectives We sought to examine saphenous vein graft (SVG) lesions that fail within the first year after operation. Background Saphenous vein grafts remain patent for approximately 10 years; how ever, up to 15%to 20%of SVGs become occluded within the first year. Methods We studied 100 patients who underwent percutaneous coronary intervention(PCI) for early (< 1 year post implantation) SVG failure lesions and compared them with a diabetes and hypercholesterolemia matched cohort of late SVG failures (>1 yea r). Coronary angiography and intravascular ultrasound images were analyzed. Resu lts The majority of patients in both groups were males who presented with unstab le angina; 36%were diabetic. Graft ages were 6.0 ±2.9 months and 105.4 ±50.8 months, respectively. The early SVG failure lesion location was more often ostia l or proximal (62%vs. 42%, respectively). Early SVG failures were angiographic ally smaller than late failures (reference: 2.47 ±0.86 mm vs. 3.26 ±0.83 mm, p < 0.001) but had similar lesion lengths. Intravascular ultrasound showed that ea rly failure lesions had smaller proximal and distal reference lumen areas (7.3± 6.8mm2 vs. 10.6±3.8mm2, p=0.026) and greater reference plaque burden than late failures (52.3%vs. 36.1%, p < 0.001). After PCI, 20.6%of early and 30.6%of l ate failure lesions had creatine kinase myocardial band(CK MB) greater than tw ice normal. Conclusions Early SVG failure is mostly proximal or ostial, lesions appear focal, and early SVGs appear smaller than late SVGs. Intravascular ultras ound shows significant reference segment plaque burden, suggesting more severe, diffuse SVG disease.
