Abstract 20606: Comparison of Saphenous Vein Graft Occlusion and Stent Thrombosis: Discrepancies in Clinical Presentation, Procedural Characteristics and Clinical Outcomes

Abstract

Background: Difference in technical complexity and clinical outcomes between percutaneous coronary intervention (PCI) for stent thrombosis (ST) and PCI for occluded saphenous vein graft (SVG) have not been systematically examined. The aim of this study was to compare clinical presentation, procedural characteristics and clinical outcomes of acute coronary syndrome (ACS) patients who underwent PCI motivated by ST with those whom PCI was motivated by SVG total occlusion. Methods: We retrospectively included all the patients admitted for ACS due to ST (ST group; n=136) or SVG occlusion (SVG group; n=279) in our institution. The SVG group was divided into the following two subgroups; patients who underwent PCI in the SVG (SVG-PCI; n=75) and those who underwent PCI in native coronary arteries (native-PCI; n=204). Clinical presentation, procedural characteristics and short-term mortality were compared between the 3 groups (ST vs SVG-PCI vs native-PCI). Results: Compared with the SVG-PCI and native-PCI groups, acute myocardial infarction (76.5% vs 58.7% vs 30.4%, p <0.001; respectively) and cardiogenic shock (24.3% vs 6.8% vs 3.5%, p <0.001; respectively) were more frequent in the ST group. Concerning procedural characteristics, SVG-PCI group had the highest number of guiding catheter, procedural time, fluoroscopic time and contrast amount, as well as the lowest angiographical success rate (Table). Patients of the ST group had the highest in-hospital mortality and a trend toward higher 30-day mortality (Table). Conclusions: The present study suggests that ST when compared to SVG occlusion although easier to treat is associated with a worse outcome especially with respect to the clinical presentation at the time of the event.