Impact of lesion location on intravascular ultrasound findings and short-term and five-year long-term clinical outcome after percutaneous coronary intervention for saphenous vein graft lesions.

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Citation: International Journal of Cardiology. 167(1):29-33, 2013 Jul 15.PMID: 22192289Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Graft Occlusion, Vascular/su [Surgery] | *Graft Occlusion, Vascular/us [Ultrasonography] | *Percutaneous Coronary Intervention/td [Trends] | *Saphenous Vein/su [Surgery] | *Saphenous Vein/us [Ultrasonography] | *Ultrasonography, Interventional/td [Trends] | Aged | Aged, 80 and over | Female | Humans | Male | Middle Aged | Percutaneous Coronary Intervention/mt [Methods] | Retrospective Studies | Time Factors | Treatment Outcome | Ultrasonography, Interventional/mt [Methods]ISSN:
  • 0167-5273
Name of journal: International journal of cardiologyAbstract: BACKGROUND: Little is known about intravascular ultrasound (IVUS) findings and acute post-percutaneous coronary intervention (PCI) outcome and long-term clinical outcome between aorto-ostial lesion and shaft lesion after PCI for saphenous vein graft (SVG) lesions.CONCLUSIONS: SVG shaft lesion has more unstable plaque morphology and this may contribute to the worse acute PCI outcomes and long-term outcomes. Copyright 2011 Elsevier Ireland Ltd. All rights reserved.METHODS: Aorto-ostial lesion was defined as those arising within 3mm of the origin of SVG and shaft lesion was defined as those arising in remaining portion of SVG. We evaluated pre- and post-PCI IVUS images of 311 SVG lesions and compared IVUS findings and acute post-PCI outcome and 5-year clinical outcome between aorto-ostial lesion (n=64) and shaft lesion (n=247).RESULTS: The presence of positive remodeling (40% vs. 22%, p=0.026), hypoechoic plaque (47% vs. 36%, p=0.035), plaque rupture (23% vs. 8%, p=0.008), multiple plaque rupture (9% vs. 2%, p=0.038), and an intraluminal mass (54% vs. 25%, p<0.001) were significantly more common in shaft lesion than in aorto-ostial lesion. Post-PCI no-reflow (15% vs. 5%, p=0.033), post-PCI tissue prolapse (TP) (40% vs. 23%, p=0.014), and post-PCI creatine kinase-MB elevation more than 3 times normal (14% vs. 8%, p=0.047) were observed more frequently after PCI for shaft lesion than for aorto-ostial lesion. At 5-year clinical follow-up, the incidences of death (25% vs. 13%, p=0.036) and myocardial infarction (24% vs. 11%, p=0.028), but not the rate of target vessel revascularization (36% vs. 25%, p=0.096), were significantly higher in patients with shaft lesion compared with those with aorto-ostial lesion.All authors: Ahn Y, Hong YJ, Jeong MH, Kang JC, Kim SW, Kim SY, Lee SY, Mintz GS, Pichard AD, Satler LF, Waksman R, Weissman NJDigital Object Identifier: Date added to catalog: 2014-04-03
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Journal Article MedStar Authors Catalog Article Available 22192289

BACKGROUND: Little is known about intravascular ultrasound (IVUS) findings and acute post-percutaneous coronary intervention (PCI) outcome and long-term clinical outcome between aorto-ostial lesion and shaft lesion after PCI for saphenous vein graft (SVG) lesions.

CONCLUSIONS: SVG shaft lesion has more unstable plaque morphology and this may contribute to the worse acute PCI outcomes and long-term outcomes. Copyright 2011 Elsevier Ireland Ltd. All rights reserved.

METHODS: Aorto-ostial lesion was defined as those arising within 3mm of the origin of SVG and shaft lesion was defined as those arising in remaining portion of SVG. We evaluated pre- and post-PCI IVUS images of 311 SVG lesions and compared IVUS findings and acute post-PCI outcome and 5-year clinical outcome between aorto-ostial lesion (n=64) and shaft lesion (n=247).

RESULTS: The presence of positive remodeling (40% vs. 22%, p=0.026), hypoechoic plaque (47% vs. 36%, p=0.035), plaque rupture (23% vs. 8%, p=0.008), multiple plaque rupture (9% vs. 2%, p=0.038), and an intraluminal mass (54% vs. 25%, p<0.001) were significantly more common in shaft lesion than in aorto-ostial lesion. Post-PCI no-reflow (15% vs. 5%, p=0.033), post-PCI tissue prolapse (TP) (40% vs. 23%, p=0.014), and post-PCI creatine kinase-MB elevation more than 3 times normal (14% vs. 8%, p=0.047) were observed more frequently after PCI for shaft lesion than for aorto-ostial lesion. At 5-year clinical follow-up, the incidences of death (25% vs. 13%, p=0.036) and myocardial infarction (24% vs. 11%, p=0.028), but not the rate of target vessel revascularization (36% vs. 25%, p=0.096), were significantly higher in patients with shaft lesion compared with those with aorto-ostial lesion.

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