| Short- and long-term outcome of narrowed saphenous vein bypass graft: a comparison of Palmaz-Schatz stent, directional coronary atherectomy, and balloon angioplasty. | |
| | |
MedLine Citation:
|
PMID: 9313608 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
Percutaneous treatment of saphenous vein graft (SVG) stenosis has been established as an alternative to repeat coronary artery bypass grafting. Intracoronary Palmaz-Schatz stent (PSS) and directional coronary atherectomy (DCA) have been suggested to provide better short- and long-term results than balloon angioplasty. Records of 840 patients with 931 SVG lesions treated with PSS (121 patients, 132 lesions), DCA (103 patients, 107 lesions), and balloon angioplasty (616 patients, 692 lesions) were reviewed. Inhospital and long-term outcome were compared among treated groups. The groups had similar clinical and angiographic baseline characteristics except for higher previously dilated grafts in the stent group and graft location among devices. Stent placement was angiographically successful in 99%, DCA in 95%, and balloon angioplasty in 93% of the lesions (p = 0.03). Quantitative angiography revealed a larger lumen diameter after procedure after PSS (3.2 mm) and DCA (3.1 mm) compared with 2.4 mm after balloon angioplasty (p = 0.0001). Angiographic complications (abrupt closure, severe dissections, or distal embolization) were evident in eight (6.1%) lesions after PSS placement, in 17 (15.9%) after DCA, and in 61 (8.8%) after balloon angioplasty. Serious in-hospital clinical complications (death, emergency coronary artery bypass grafting, or Q-wave myocardial infarction) were similar among devices. Survival rates were similar among the groups (p = 0.15). Repeat revascularization at follow-up was reported in 58 (60.4%) of patients after PSS, in 48 (51.1%) after DCA, and in 280 (49.4%) after balloon angioplasty. Correlates of additional revascularization at follow-up were older grafts, calcific lesions, previously dilated grafts, longer lesions, and patients with lower ejection fractions (odds ratio 1.06, 1.34, 1.43, 1.04, and 1.01, respectively). Correlates of mortality rate at follow-up were older patients, patients with lower ejection fractions, and distal embolization (odds ratio 1.04, 1.04, and 1.92, respectively). These data suggest that in patents with SVG stenosis the initial success and morbidity rates are similar when comparing PSS and DCA with balloon angioplasty. Although a larger lumen is obtained with PSS and DCA, patients who underwent balloon angioplasty had similar rates of cardiac events and requirements for additional procedures at follow-up. |
| | |
Authors:
|
R Waksman; W S Weintraub; Z Ghazzal; N A Scott; Y Shen; S B King; J S Douglas |
Related Documents
:
|
3156288 - Percutaneous transluminal coronary angioplasty: the early dunedin experience. 2032278 - Multicenter evaluation of a new fixed-wire coronary angioplasty catheter system: clinic... 1512338 - Prospective analysis of possible myocardial damage or hemolysis occurring as a result o... 2947688 - Salvage coronary angioplasty for symptoms refractory to medical therapy. 18300868 - Impaired left ventricular synchronicity in hypertensive patients with ventricular hyper... 16839428 - The nomenclature, definition and classification of hypoplastic left heart syndrome. |
Publication Detail:
|
Type: Comparative Study; Journal Article |
Journal Detail:
|
Title: American heart journal Volume: 134 ISSN: 0002-8703 ISO Abbreviation: Am. Heart J. Publication Date: 1997 Aug |
Date Detail:
|
Created Date: 1997-10-16 Completed Date: 1997-10-16 Revised Date: 2006-11-15 |
Medline Journal Info:
|
Nlm Unique ID: 0370465 Medline TA: Am Heart J Country: UNITED STATES |
Other Details:
|
Languages: eng Pagination: 274-81 Citation Subset: AIM; IM |
Affiliation:
|
Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, USA. rxw8@mhg.edu |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Aged Angioplasty, Transluminal, Percutaneous Coronary* / adverse effects Atherectomy, Coronary* / adverse effects Constriction, Pathologic / therapy Coronary Artery Bypass Coronary Disease / mortality, surgery Disease-Free Survival Female Follow-Up Studies Humans Male Middle Aged Myocardial Infarction / etiology Retrospective Studies Saphenous Vein / pathology*, transplantation Stents* / adverse effects Treatment Outcome |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Laser balloon angioplasty combined with local intracoronary heparin therapy: immediate and short-ter...
Next Document: Fibromuscular dysplasia of small coronary arteries and fibrosis in the basilar ventricular septum in...