951-75 Comparative Analysis of Long Term Clinical Outcomes After Native Coronary versus Saphenous Vein Graft Stent Implantation

Abstract

To assess the late (3 years) clinical outcomes of JJIS stent (S) placement in the treatment of native coronary(NC) and saphenous vein graft (SVG) lesions, we compared baseline factors, procedural results and late clinical events in 112 pts (122 lesions) with native and 118 pts (153 lesions) with SVG lesions treated with S at the Washington Hospital Center. Pts with SVG lesions were older, had more frequent multivessel disease, history of prior MI, ostial and denovo lesions and lower ejection fractions (all p < 0.005). The initial and final % stenosis, procedural success and major complications (death, Q wave MI, CABG) were similar between the 2 groups. Clinical events Native 1/3 yr SVG 1/3 yr P value (log-rank) Death (%) 0/1.5 8/22 0.0003 Q-wave MI (%) 1/1 5/8 0.06 TLR(%) 26/29 28/49 0.08 Non-TLR (%) 0/9 10/17 0.02 TLR = target lesion revascularization (repeat PTCA or CABG) and EFS = event free survival (freedom from death, Q-wave MI, and TLR). During the first year after S placement, SVG lesions (compared with NC) had higher mortality and Q-wave MI. similar TLR and greater non-TLR events. Between 1 and 3 years, in SVG pts there was a further dramatic increase in mortality and TLR resulting in a 3-year actuarial EFS of only 37% (see figure). In contrast, NC behavior was stable between 1 and 3 years with no further mortality, Q-wave MI, or TLR, but a 10% incidence of non-TLR events. In conclusion: Despite similar procedural results, SVG vs native pts treated with S manifested disparate late clinical responses. Disturbingly, in SVG pts there was progressive mortality(in part due to increased pt morbidity) and additional TLR events after the first year of S implantation (ie. “late” restenosis) causing a striking attrition in 3 year EFS.