Late Myocardial Ischemic Events After Saphenous Vein Graft Intervention—Importance of Initially “Nonsignificant” Vein Graft Lesions
Patients undergoing percutaneous coronary revascularization (PCR) for narrowed saphenous vein grafts (SVGs) have a high incidence of subsequent cardiac events, but the relative contribution of treated and untreated SVGs, and of native coronary narrowings to late events is uncertain. This study evalu...
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| Veröffentlicht in: | The American journal of cardiology 1997-06, Vol.79 (11), p.1460-1464 |
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| creator | Ellis, Stephen G. Brener, Sorin J. DeLuca, Sue Tuzcu, E.Murat Raymond, Russell E. Whitlow, Patrick L. Topol, Eric J. |
| description | Patients undergoing percutaneous coronary revascularization (PCR) for narrowed saphenous vein grafts (SVGs) have a high incidence of subsequent cardiac events, but the relative contribution of treated and untreated SVGs, and of native coronary narrowings to late events is uncertain. This study evaluated the role of progression of SVG disease at untreated sites to cardiac events in these patients. All patients with successful PCR of SVG lesions who were enrolled in clinical trials with mandated repeat angiography from 1990 to 1994 were studied. One hundred three patients (age 63 ± 8 years, 82% men, ejection fraction 54 ± 12%, graft age 8 ± 4 years), contributing 1,095 analyzable 15- to 25-mm SVG segments were followed 29 ± 13 months (4 patients were lost to follow-up). Actuarial event-free (death, myocardial infarction, bypass surgery, or PCR) and overall survival at 12 months were 47 ± 5% and 94 ± 2%, respectively. Fifty-six percent of all early (≤12 months) events resulted from ischemia from recurrence at initially treated SVG sites, 26% at nontreated SVG sites, and 14% at nontreated native coronary sites. By 36 months, event-free and overall survival were 25 ± 6% and 86 ± 4%, respectively. Events occurring >12 months after initial treatment resulted most frequently from ischemia from progression of narrowing at untreated SVG sites (46%). Ischemic events from initially untreated SVG sites were correlated with initial percent stenosis (initial, 41% to 50%; 45% events, 31% to 40%; 18% events, ≤30%; 2% events, p 75%; 43% events, 50% to 75%; 27% events, |
| doi_str_mv | 10.1016/S0002-9149(97)00171-9 |
| format | Article |
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One hundred three patients undergoing coronary intervention of vein graft narrowings were followed 29 ± 13 months to ascertain correlates of recurrent ischemic events >12 months (36 months event-free survival = 25 ± 6%). Late recurrent events were most closely associated with progression of narrowings 41% to 50%, and to a lesser extent 31% to 40%, at baseline study.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/S0002-9149(97)00171-9</identifier><identifier>PMID: 9185633</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Aged ; Biological and medical sciences ; Cardiovascular disease ; Coronary Angiography ; Coronary Artery Bypass - adverse effects ; Coronary Artery Bypass - methods ; Coronary Disease - diagnostic imaging ; Coronary Disease - surgery ; Disease Progression ; Disease-Free Survival ; Female ; Humans ; Male ; Medical procedures ; Medical research ; Medical sciences ; Middle Aged ; Myocardial Ischemia - diagnostic imaging ; Myocardial Ischemia - etiology ; Prospective Studies ; Saphenous Vein - pathology ; Saphenous Vein - transplantation ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the heart ; Survival Analysis ; Time Factors ; Treatment Outcome</subject><ispartof>The American journal of cardiology, 1997-06, Vol.79 (11), p.1460-1464</ispartof><rights>1997 Elsevier Science Inc.</rights><rights>1997 INIST-CNRS</rights><rights>Copyright Elsevier Sequoia S.A. Jun 1, 1997</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c416t-6f700863c845452325e657cb96b8cc5a5fe72c7e6a578ceb95471c1e56a318923</citedby><cites>FETCH-LOGICAL-c416t-6f700863c845452325e657cb96b8cc5a5fe72c7e6a578ceb95471c1e56a318923</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/S0002-9149(97)00171-9$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>315,781,785,3551,27929,27930,46000</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=2694586$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9185633$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ellis, Stephen G.</creatorcontrib><creatorcontrib>Brener, Sorin J.</creatorcontrib><creatorcontrib>DeLuca, Sue</creatorcontrib><creatorcontrib>Tuzcu, E.Murat</creatorcontrib><creatorcontrib>Raymond, Russell E.</creatorcontrib><creatorcontrib>Whitlow, Patrick L.</creatorcontrib><creatorcontrib>Topol, Eric J.</creatorcontrib><title>Late Myocardial Ischemic Events After Saphenous Vein Graft Intervention—Importance of Initially “Nonsignificant” Vein Graft Lesions</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>Patients undergoing percutaneous coronary revascularization (PCR) for narrowed saphenous vein grafts (SVGs) have a high incidence of subsequent cardiac events, but the relative contribution of treated and untreated SVGs, and of native coronary narrowings to late events is uncertain. This study evaluated the role of progression of SVG disease at untreated sites to cardiac events in these patients. All patients with successful PCR of SVG lesions who were enrolled in clinical trials with mandated repeat angiography from 1990 to 1994 were studied. One hundred three patients (age 63 ± 8 years, 82% men, ejection fraction 54 ± 12%, graft age 8 ± 4 years), contributing 1,095 analyzable 15- to 25-mm SVG segments were followed 29 ± 13 months (4 patients were lost to follow-up). Actuarial event-free (death, myocardial infarction, bypass surgery, or PCR) and overall survival at 12 months were 47 ± 5% and 94 ± 2%, respectively. Fifty-six percent of all early (≤12 months) events resulted from ischemia from recurrence at initially treated SVG sites, 26% at nontreated SVG sites, and 14% at nontreated native coronary sites. By 36 months, event-free and overall survival were 25 ± 6% and 86 ± 4%, respectively. Events occurring >12 months after initial treatment resulted most frequently from ischemia from progression of narrowing at untreated SVG sites (46%). Ischemic events from initially untreated SVG sites were correlated with initial percent stenosis (initial, 41% to 50%; 45% events, 31% to 40%; 18% events, ≤30%; 2% events, p <0.001) and reference SVG diameter (p = 0.003). Recurrent ischemic events from initially treated SVG sites were independently correlated with initial percent stenosis (initial >75%; 43% events, 50% to 75%; 27% events, <50%; 18% events, p = 0.01), but not with final percent stenosis. The frequent occurrence of events from nontreated 41% to 50% stenoses suggests a need for increased surveillance in patients with these lesions. The low incidence of events from initially treated lesions <50% suggests that the hypothesis that “nonsignificant” 41% to 50% lesions might best be treated at the time other more severe narrowings are treated should be examined.
One hundred three patients undergoing coronary intervention of vein graft narrowings were followed 29 ± 13 months to ascertain correlates of recurrent ischemic events >12 months (36 months event-free survival = 25 ± 6%). Late recurrent events were most closely associated with progression of narrowings 41% to 50%, and to a lesser extent 31% to 40%, at baseline study.</description><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Cardiovascular disease</subject><subject>Coronary Angiography</subject><subject>Coronary Artery Bypass - adverse effects</subject><subject>Coronary Artery Bypass - methods</subject><subject>Coronary Disease - diagnostic imaging</subject><subject>Coronary Disease - surgery</subject><subject>Disease Progression</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Medical procedures</subject><subject>Medical research</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Myocardial Ischemia - diagnostic imaging</subject><subject>Myocardial Ischemia - etiology</subject><subject>Prospective Studies</subject><subject>Saphenous Vein - pathology</subject><subject>Saphenous Vein - transplantation</subject><subject>Surgery (general aspects). 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Graft diseases</subject><subject>Surgery of the heart</subject><subject>Survival Analysis</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1997</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkcFuEzEURS0EKiHwCZUshBBdTLHHY3u8QlVVSqRQFgW2luO8oa5m7NR2KmWXLXuW9OfyJThNFCE2rCzrnnf13r0IHVNySgkV768JIXWlaKPeKXlCCJW0Uk_QiLZSVVRR9hSNDshz9CKl2_KllIsjdKRoywVjI_RzajLgz6tgTZw70-NJsjcwOIsv7sHnhM-6DBFfm8UN-LBM-Ds4jy-j6TKe-CJtKRf8Zv1rMixCzMZbwKErosvFr1_hzfr3VfDJ_fCuc9b4vFk__G0zhVQM0kv0rDN9glf7d4y-fbz4ev6pmn65nJyfTSvbUJEr0UlCWsFs2_CG16zmILi0MyVmrbXc8A5kbSUIw2VrYaZ4I6mlwIVhtFU1G6O3O99FDHdLSFkPLlnoe-OhHKilIrxpFSng63_A27CMvuyma0YYZ03dFojvIBtDShE6vYhuMHGlKdHbnvRjT3pbglZSP_akVZk73psvZwPMD1P7Yor-Zq-bZE3fxZKrSwesFqrhJYUx-rDDoCR27yDqZB2UCuYugs16Htx_FvkDpmOyXw</recordid><startdate>19970601</startdate><enddate>19970601</enddate><creator>Ellis, Stephen G.</creator><creator>Brener, Sorin J.</creator><creator>DeLuca, Sue</creator><creator>Tuzcu, E.Murat</creator><creator>Raymond, Russell E.</creator><creator>Whitlow, Patrick L.</creator><creator>Topol, Eric J.</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>19970601</creationdate><title>Late Myocardial Ischemic Events After Saphenous Vein Graft Intervention—Importance of Initially “Nonsignificant” Vein Graft Lesions</title><author>Ellis, Stephen G. ; Brener, Sorin J. ; DeLuca, Sue ; Tuzcu, E.Murat ; Raymond, Russell E. ; Whitlow, Patrick L. ; Topol, Eric J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c416t-6f700863c845452325e657cb96b8cc5a5fe72c7e6a578ceb95471c1e56a318923</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1997</creationdate><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Cardiovascular disease</topic><topic>Coronary Angiography</topic><topic>Coronary Artery Bypass - adverse effects</topic><topic>Coronary Artery Bypass - methods</topic><topic>Coronary Disease - diagnostic imaging</topic><topic>Coronary Disease - surgery</topic><topic>Disease Progression</topic><topic>Disease-Free Survival</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Medical procedures</topic><topic>Medical research</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Myocardial Ischemia - diagnostic imaging</topic><topic>Myocardial Ischemia - etiology</topic><topic>Prospective Studies</topic><topic>Saphenous Vein - pathology</topic><topic>Saphenous Vein - transplantation</topic><topic>Surgery (general aspects). 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Graft diseases</topic><topic>Surgery of the heart</topic><topic>Survival Analysis</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ellis, Stephen G.</creatorcontrib><creatorcontrib>Brener, Sorin J.</creatorcontrib><creatorcontrib>DeLuca, Sue</creatorcontrib><creatorcontrib>Tuzcu, E.Murat</creatorcontrib><creatorcontrib>Raymond, Russell E.</creatorcontrib><creatorcontrib>Whitlow, Patrick L.</creatorcontrib><creatorcontrib>Topol, Eric J.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ellis, Stephen G.</au><au>Brener, Sorin J.</au><au>DeLuca, Sue</au><au>Tuzcu, E.Murat</au><au>Raymond, Russell E.</au><au>Whitlow, Patrick L.</au><au>Topol, Eric J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Late Myocardial Ischemic Events After Saphenous Vein Graft Intervention—Importance of Initially “Nonsignificant” Vein Graft Lesions</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>1997-06-01</date><risdate>1997</risdate><volume>79</volume><issue>11</issue><spage>1460</spage><epage>1464</epage><pages>1460-1464</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><coden>AJCDAG</coden><abstract>Patients undergoing percutaneous coronary revascularization (PCR) for narrowed saphenous vein grafts (SVGs) have a high incidence of subsequent cardiac events, but the relative contribution of treated and untreated SVGs, and of native coronary narrowings to late events is uncertain. This study evaluated the role of progression of SVG disease at untreated sites to cardiac events in these patients. All patients with successful PCR of SVG lesions who were enrolled in clinical trials with mandated repeat angiography from 1990 to 1994 were studied. One hundred three patients (age 63 ± 8 years, 82% men, ejection fraction 54 ± 12%, graft age 8 ± 4 years), contributing 1,095 analyzable 15- to 25-mm SVG segments were followed 29 ± 13 months (4 patients were lost to follow-up). Actuarial event-free (death, myocardial infarction, bypass surgery, or PCR) and overall survival at 12 months were 47 ± 5% and 94 ± 2%, respectively. Fifty-six percent of all early (≤12 months) events resulted from ischemia from recurrence at initially treated SVG sites, 26% at nontreated SVG sites, and 14% at nontreated native coronary sites. By 36 months, event-free and overall survival were 25 ± 6% and 86 ± 4%, respectively. Events occurring >12 months after initial treatment resulted most frequently from ischemia from progression of narrowing at untreated SVG sites (46%). Ischemic events from initially untreated SVG sites were correlated with initial percent stenosis (initial, 41% to 50%; 45% events, 31% to 40%; 18% events, ≤30%; 2% events, p <0.001) and reference SVG diameter (p = 0.003). Recurrent ischemic events from initially treated SVG sites were independently correlated with initial percent stenosis (initial >75%; 43% events, 50% to 75%; 27% events, <50%; 18% events, p = 0.01), but not with final percent stenosis. The frequent occurrence of events from nontreated 41% to 50% stenoses suggests a need for increased surveillance in patients with these lesions. The low incidence of events from initially treated lesions <50% suggests that the hypothesis that “nonsignificant” 41% to 50% lesions might best be treated at the time other more severe narrowings are treated should be examined.
One hundred three patients undergoing coronary intervention of vein graft narrowings were followed 29 ± 13 months to ascertain correlates of recurrent ischemic events >12 months (36 months event-free survival = 25 ± 6%). Late recurrent events were most closely associated with progression of narrowings 41% to 50%, and to a lesser extent 31% to 40%, at baseline study.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>9185633</pmid><doi>10.1016/S0002-9149(97)00171-9</doi><tpages>5</tpages></addata></record> |
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| issn | 0002-9149 1879-1913 |
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| subjects | Aged Biological and medical sciences Cardiovascular disease Coronary Angiography Coronary Artery Bypass - adverse effects Coronary Artery Bypass - methods Coronary Disease - diagnostic imaging Coronary Disease - surgery Disease Progression Disease-Free Survival Female Humans Male Medical procedures Medical research Medical sciences Middle Aged Myocardial Ischemia - diagnostic imaging Myocardial Ischemia - etiology Prospective Studies Saphenous Vein - pathology Saphenous Vein - transplantation Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart Survival Analysis Time Factors Treatment Outcome |
| title | Late Myocardial Ischemic Events After Saphenous Vein Graft Intervention—Importance of Initially “Nonsignificant” Vein Graft Lesions |
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