Document Detail


Clinical, angiographic, and intravascular ultrasound characteristics of early saphenous vein graft failure.
MedLine Citation:
PMID:  15234406     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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; however, 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 year). Coronary angiography and intravascular ultrasound images were analyzed. RESULTS: The majority of patients in both groups were males who presented with unstable 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 ostial or proximal (62% vs. 42%, respectively). Early SVG failures were angiographically 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 early failure lesions had smaller proximal and distal reference lumen areas (7.3 +/- 6.8 mm2 vs. 10.6 +/- 3.8 mm2, 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 late failure lesions had creatine kinase-myocardial band (CK-MB) greater than twice normal. CONCLUSIONS: Early SVG failure is mostly proximal or ostial, lesions appear focal, and early SVGs appear smaller than late SVGs. Intravascular ultrasound shows significant reference segment plaque burden, suggesting more severe, diffuse SVG disease.
Authors:
Daniel A Caños; Gary S Mintz; Chalak O Berzingi; Sue Apple; Jun-ichi Kotani; Augusto D Pichard; Lowell F Satler; William O Suddath; Ron Waksman; Joseph Lindsay; Neil J Weissman
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  44     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2004 Jul 
Date Detail:
Created Date:  2004-07-05     Completed Date:  2004-09-23     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  53-6     Citation Subset:  AIM; IM    
Affiliation:
Cardiovascular Research Institute, Washington Hospital Center, Washington, DC 20010, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Transluminal, Percutaneous Coronary
Biological Markers / blood
Blood Flow Velocity / physiology
Coronary Angiography*
Coronary Disease / diagnosis,  physiopathology,  therapy
Creatine Kinase / blood
Creatine Kinase, MB Form
Female
Graft Occlusion, Vascular / diagnosis*,  etiology*,  physiopathology
Humans
Isoenzymes / blood
Male
Middle Aged
Retrospective Studies
Saphenous Vein / immunology,  radiography,  transplantation*
Statistics as Topic
Time Factors
Treatment Outcome
Ultrasonography, Interventional*
Vascular Patency / physiology
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Isoenzymes; EC 2.7.3.2/Creatine Kinase; EC 2.7.3.2/Creatine Kinase, MB Form

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