710-5 Progressive Deterioration in Late (2-Year) Clinical Outcomes After Stent Implantation in Saphenous Vein Grafts: The Multicenter JJIS Experience

Abstract

Late clinical follow-up (after I-year) in patients treated with native coronary stents demonstrates no further clinical events (death or MI) and rare delayed target lesion revascularization (TLR = repeat PTCA or CABG). To examine the long-term effects of stent placement in saphenous vein grafts (SVG), we evaluated all follow-up clinical data in 661 consecutive patients (775 SVG lesions) from the JJIS multicenter registry (17 sites). Baseline demographics were pertinent for a high incidence of unstable angina (72%), heart failure (22%), and high surgical risk status (49%). The mean SVG age was 9 ± 4 years, and the mean ejection fraction was 49 ± 14%. Overall procedure success (<50% residual stenosis without in-hospital death. MI, or CABG) was 92%, and subacute thrombosis was documented in 9 patients (14%). Actuarial follow-up event rates:Events6-months12-months24-months– Death (%)5814– MI(%)788– CABG (%)7912– PTCA(%)6812– Event-free survival (%)756755Event-free survival = freedom from death, MI. CABG or PTCA Event-free survival = freedom from death, MI. CABG or PTCA Similar to PTCA in SVG lesions and in contrast to stents in native coronaries, patients with stents in SVG's exhibit a disappointing attrition in late clinical outcomes beyond one year, Both increasing mortality and repeat revascularization procedures contribute to the 2-year 55% event-free survival. We surmise that further deterioration at the stent site (i.e. “late” restenosis), increasing non-TLR events, and less favorable baseline characteristics are responsible for these findings.