Saphenous Vein Graft Intervention Research Articles

A new predictor of coronary no-reflow phenomenon after percutaneous coronary intervention in saphenous vein grafts: Eisonophil

Introduction: Coronary no-reflow phenomenon is an important factor that causes increased mortality and morbidity in percutaneous coronary intervention procedures. How this happened is a subject that is still under investigation and has no clear answer. In this study, we examined the effect of eosinophil values in coronary no-reflow. Methods: The study was designed retrospectively. Four hundred four patients who underwent coronary bypass were included in the study; 153 in the no-reflow group and 251 in the regular coronary flow group. The relationship between eosinophil values and no-reflow was examined. Results: In the examination between no-reflow and eosinophil, there was a significant difference between the groups (p <0.001), Multivariate analysis showed that presence of coronary stent (p = 0.001), diabetes mellitus (P = 0.001), neutrophils (P = 0.001), eosinophil (P = 0.001) were effective coronary no-reflow phenomena. Conclusions: Many factors play a role in developing no-reflow and eosinophil height among these factors. It should be kept in mind that no-reflow may develop if eosinophil elevation is present in coronary artery disease.

Percutaneous Coronary Intervention in a Saphenous Vein Graft Failure: A Case Report

Abstract: Recent published data from the Society of Thoracic Surgery (STS) national database displayed that among patients aged >65 years old who survived following an initial coronary artery bypass graft (CABG) operation, rates of repeat revascularization at 1, 5, 10, and 18 years were 2%, 8%, 16%, and 25%, respectively. The most preferred mode of revascularization was percutaneous coronary intervention (PCI). While remain the most frequently used conduits beside left internal mammary artery (LIMA), saphenous vein grafts (SVGs) have high failure rates. Percutaneous coronary intervention in SVGs is associated with an increased risk of distal coronary embolization, commonly resulting in periprocedural MI. We reported a 79-year-old male patient admitted due to progressive symptoms of chronic coronary syndrome. The patient had a history of hypertension and a CABG surgery in 2012. Electrocardiogram showed ischemia and old myocardial infarction (OMI) in inferior leads as well as poor R wave progression in the precordial leads. Transthoracic echocardiogram displayed a normal ejection fraction but impaired left ventricular (LV) diastolic relaxation. Diagnostic coronary angiography revealed a 70% tubular stenosis in proximal part of SVG supplying posterior descending artery, patent LIMA graft to left anterior descending artery, and complex lesion on native vessel (chronic total occlusion in mid right coronary artery). Implantation of drug eluting stent in SVG-posterior descending artery was performed. Direct-stenting PCI technique using undersized-stent was done to prevent any complications. In conclusion, despite the high risk of complications, vein graft intervention was successfully performed without any complications. Since the high rates of in-stent restenosis following PCI in SVGs, long-term dual antiplatelet therapy should be commenced in this patient. Keywords: saphenous vein graft; vein graft intervention; percutaneous coronary intervention

Abstract 14961: Revitalizing Graft Patency: Intravascular Lithotripsy in Calcified Saphenous Vein Graft to Left Anterior Descending Artery Stenosis

A 73-year-old man with coronary artery disease (CAD), coronary artery bypass graft, heart failure [EF 25%] & hypertension presented with Non-ST Segment Myocardial Infarction. Angiography revealed multivessel CAD with chronic total occlusion (CTO) of mid-left anterior descending (LAD) after a large first diagonal branch, CTO of mid-left circumflex & distal right coronary artery. Saphenous vein graft (SVG) to obtuse marginal was patent. SVG-diagonal & SVG-ramus intermedius were occluded. Mid SVG-LAD showed severe calcified stenosis (Fig. 1A). Native LAD beyond the SVG provided left to right collaterals to right posterior descending artery. Complex high-risk coronary intervention was performed on the SVG-LAD with mechanical circulatory support (MCS; Impella CP). SVG-LAD had a balloon undilatable lesion despite high pressure inflation with 4.0 mm cutting balloon (Fig. 1B). Intravascular ultrasound (IVUS) revealed severe stenosis with extensive circumferential calcification (Fig. 1C). Subsequently, intravascular lithotripsy (IVL) with 4.0 mm Shockwave balloon followed by high pressure balloon angioplasty with 4.5 mm noncompliant (NC) balloon was performed with significant luminal gain and fractures in calcium (Fig. 1D). The lesion was treated with 5.0 mm drug eluting stents that were post dilated with 5.0 mm NC balloon with excellent angiographic and IVUS result (Figs. 1E & F). MCS was successfully removed at the end of the case.SVG grafts are associated with poor long-term patency compared to arterial grafts. PCI to SVG has a high failure rate and PCI of native vessel is often preferable. High risk SVG interventions with atherectomy have been recently reported, though data is limited. IVL has been safely used in heavily calcified native coronary arteries, however, its use in SVG disease is rare. We report the first off-label use IVL of SVG-LAD with MCS for treatment of a last-remaining conduit. Additional studies to assess IVL efficacy in vein grafts are warranted.

The stress hyperglycemic ratio can predict the no-reflow phenomenon following saphenous vein graft intervention in patients with acute coronary syndrome.

The no-reflow phenomenon (NRP) is a common complication of saphenous vein graft (SVG) interventions. The aim of this study was to investigate the effect of the stress hyperglycemia ratio (SHR) on the development of NRP in patients with acute coronary syndrome (ACS) undergoing percutaneous SVG intervention. The study included 223 patients who presented at our center with ACS, had a history of coronary artery bypass graft and underwent a saphenous graft procedure. The relationship between SHR calculated at the time of presentation from glucose and HbA1c values, and the development of NRP evaluated after the procedure with angiography was determined with univariate and multivariate binary regression analysis. The study population was separated into two groups as those who developed and did not develop NRP. Mean age was determined to be significantly higher in the group that did not develop NRP compared to the group with NRP (p: 0.004). Angiographically, the thrombus burden was determined to be significantly higher in the group that developed NRP (p < 0.001). Patients were separated into 3 tertiles according to the SHR level (T1, T2, T3), and the rate of NRP development was determined at a significantly higher rate in the T3 group (p < 0.001). This study showed that SHR, a parameter that can be easily calculated noninvasively, is an independent predictor of NRP development in ACS patients undergoing saphenous interventions. In addition, high thrombus burden and predilatation before stenting were also found to be factors that increase the likelihood of developing NRP.

The Relationship between CHA2DS2-VASc Score and Reperfusion Success in Elective Percutaneous Saphenous Vein Graft Interventions

The Relationship between CHA2DS2-VASc Score and Reperfusion Success in Elective Percutaneous Saphenous Vein Graft Interventions

Assessment of systemic immune-inflammation index as an independent surrogate biomarker of no-reflow phenomenon in acute coronary syndrome patients with coronary artery bypass grafting undergoing percutaneous coronary intervention of saphenous vein graft.

Numerous mechanisms have been proposed for the no-reflow phenomenon (NRP) in the literature including leukocyte intravascular plugging, microembolisms, and extrinsic coagulation pathway activation. Some of the more recent studies suggested a relationship between NRP and systemic immune-inflammation index (SII) in different contexts. To this end, the objective of this study was to investigate the relationship between NRP and SII in acute coronary syndrome (ACS) patients with coronary artery bypass grafting (CABG) who underwent percutaneous transluminal coronary angioplasty (PTCA) or percutaneous coronary intervention (PCI) of saphenous vein graft (SVG). The sample of this retrospective study consisted of 124 ACS patients with CABG who underwent PTCA/PCI of SVG. The incidence of NRP in the study group was 30.6% (n=38). The results of the multivariate logistic regression analysis indicated that ST-elevation myocardial infarction (STEMI) and SII were independent predictors for NRP (p<0.05). The receiver operating characteristic (ROC) curve analysis revealed that the optimal cut-off value of SII in predicting the development of NRP in patients undergoing PTCA/PCI of SVG and the sensitivity and specificity values thereof are 975, 74%, and 80%, respectively [Area under the curve (AUC): 0.84, 95% confidence interval (CI): 0.76-0.91, p-value <0.001]. The study findings indicated that SII, which can be easily calculated from a single complete blood count test, is an independent predictor of the development of NRP in ACS patients undergoing PTCA/PCI of the SVG.

Primary percutaneous coronary intervention of great saphenous vein grafts in a patient with central and peripheral artery disease – how to approach?

Primary percutaneous coronary intervention of great saphenous vein grafts in a patient with central and peripheral artery disease – how to approach?

76 INSIDE VEIN GRAFT FAILURE: A WORK FOR OCT

Abstract An 84-years-old woman with prior history of triple coronary artery bypass graft and subsequent percutaneous coronary intervention (PCI) of saphenous vein graft (SVG) for right coronary artery (RCA) was admitted for non-ST-elevation myocardial infarction and newly diagnosed atrial fibrillation. Coronary angiography showed chronic occlusion of native vessels and good flow in all grafts, in absence of critical stenoses. However, SVG for RCA presented a small filling defect of non-univocal interpretation (atherothrombosis, thromboembolus, venous valve). Optical coherence tomography (OCT) was performed for better assessment of the lesion, which was found to be a red thrombus, overlying a ruptured thin-cap fibroatheroma. To reduce the risk of distal embolization, a well-known complication of SVG PCI, direct stenting with conservative stent sizing was performed: everolimus-eluting stent diameter (3,5 mm) was chosen according to mean reference lumen diameter, while length (18 mm) was determined to obtain complete plaque coverage. Repeated OCT showed proximal stent malapposition and underexpansion at the mid portion. The stent was post-dilated with 4,0×12 mm non-compliant balloon and final OCT showed correction of both malapposition and underexpansion. The presented case offers an example of the advantages of intravascular imaging in diagnosis and treatment of SVG lesions. Venous grafts have high failure rate: up to 12% of graft are occluded before hospital discharge and up to 60% after 10 years. While in the first year graft occlusion is mainly caused by neointimal hyperplasia, after this period neoatherosclerosis is the leading cause of failure, as exemplified in the case. Intravascular imaging, and particularly OCT, may help to elucidate graft failure mechanism, with important implications for treatment strategy. Moreover, SVG interventions have higher incidence procedural complications, particularly no-reflow and periprocedural myocardial infarction, due to high plaque burden and friable atheromatous material. Proposed strategies to mitigate procedural risk include use of embolic protection devices, direct stenting and use of undersized stents. In this complex setting, intravascular imaging can guide stent sizing and optimization, thus reducing procedural complications and long-term lesion failure.

Percutaneous coronary intervention of native coronary artery versus saphenous vein graft in patients with prior coronary artery bypass graft surgery: Rationale and design of the multicenter, randomized PROCTOR trial

Patients with prior coronary artery bypass grafting (CABG) frequently require repeat percutaneous revascularization due to advanced age, progressive coronary artery disease and bypass graft failure. Percutaneous coronary intervention (PCI) of either the bypass graft or the native coronary artery may be performed. Randomized trials comparing native vessel PCI with bypass graft PCI are lacking and long-term outcomes have not been reported. PROCTOR (NCT03805048) is a prospective, multicenter, randomized controlled trial, that will include 584 patients presenting with saphenous vein graft (SVG) failure and a clinical indication for revascularization, as determined by the local Heart Team. The trial is designed to compare the clinical and angiographic outcomes in patients randomly allocated in a 1:1 fashion to either a strategy of native vessel PCI or SVG PCI. The primary study endpoint is a 3-year composite of major adverse cardiac events (MACE: all-cause mortality, non-fatal target coronary territory myocardial infarction [MI], or clinically driven target coronary territory revascularization). At 3-years, after evaluation of the primary endpoint, follow-up invasive coronary angiography will be performed. Secondary endpoints comprise individual components of MACE at 1, 3 and 5 years follow-up, PCI-related MI, MI >48 hours after index PCI, target vessel failure, target lesion revascularization, renal failure requiring renal-replacement therapy, angiographic outcomes at 3-years and quality of life (delta Seattle Angina Questionnaire, Canadian Cardiovascular Society Grading Scale and Rose Dyspnea Scale). PROCTOR is the first randomized trial comparing an invasive strategy of native coronary artery PCI with SVG PCI in post-CABG patients presenting with SVG failure.

Association of CABG SYNTAX score with long term clinical outcomes in patients with acute myocardial infarction undergoing SVG PCI.

The CABG SYNTAX score (CSS) has been recommended as an objective and quantitative evaluation tool for coronary anatomic complexity after CABG. We aimed at evaluating the long-term prognostic value of the CSS and its relationship with the composite criteria of all-cause death, cerebrovascular accident (CVA) and/or non-fatal myocardial infarction (MI) in patients who underwent percutaneous coronary intervention (PCI) of saphenous vein graft (SVG). We retrospectively evaluated 232 patients who were admitted with MI and underwent PCI of SVGs, between 2012 and 2018. The study population was divided into two groups according to the results of the median pre-PCI CSS. The composite criteria of all-cause death/CVA/non-fatal MI were observed in 107 patients (46.1%). The incidence of the primary endpoint was significantly higher among the patients with a high pre-PCI CSS (p < .001). Multivariable Cox regression analyses demonstrated that both pre-PCI CSS (HR = 1.678, 95% CI = 1.082-2.602, p = .021) and post-PCI CSS (HR = 1.663, 95% CI = 1.066-2.596, p = .025) were significantly associated with the primary endpoint. The Kaplan-Meier cumulative curves divided by the median of the pre-PCI CSS demonstrated that, compared with the low pre-PCI CSS group, the high-score group was associated at five years with higher composite criteria of all-cause death/CVA/non-fatal MI (low, 40.3%; high, 57.8%; p = .015). Pre-PCI CSS is a significant prognostic factor for the long-term clinical outcomes in patients with previous CABG who underwent PCI of SVG.

One-year outcomes of percutaneous coronary intervention in native coronary arteries versus saphenous vein grafts in patients with prior coronary artery bypass graft surgery.

BackgroundPatients with prior coronary artery bypass graft (CABG) surgery often require percutaneous coronary intervention (PCI). Data are still limited in regards to the outcomes of native saphenous vein graft (SVG) PCI after CABG.MethodsWe performed a retrospective study in a tertiary reference cardiac center of consecutive patients who underwent PCI after CABG. The data were collected for patients who underwent either native or graft PCI from January 2008 to December 2018. Arterial graft PCIs were excluded. Multivariable Cox regression analysis with propensity matching was performed, and major adverse cardiac events (MACE) outcomes including death or myocardial infarction (MI) or revascularization were assessed at 1-year after each index procedure.ResultsA total of 435 PCI were performed in 401 patients (209 had native PCI and 192 had graft PCI). Target lesions were classified as following: 235 (54%) native coronary arteries and 200 (46%) SVG. Propensity matching resulted in 167 matched pairs. In multivariable Cox regression graft PCI relative to native PCI was an independent risk factor for MACE (hazard ratio [HR] 1.725, 95% confidence interval [CI] 1.049–2.837) which was primarily driven by increased incidence in revascularization (HR 2.218, 95% CI 1.193–4.122) and MI (HR 2.248, 95% CI 1.220–4.142) and with no significant difference in mortality (HR 1.118, 95% CI 0.435–2.870).ConclusionsCompared with native coronary PCI, bypass graft PCI was significantly associated with higher incidence of MACE at 1-year and this was mainly driven by MI and revascularization.

TCTAP A-033 Percutaneous Coronary Intervention of Saphenous Vein Graft in Post-CABG Patient - Outcome Experiences at Our Center - SVG to OM are More Likely to Develop Occlusion

TCTAP A-033 Percutaneous Coronary Intervention of Saphenous Vein Graft in Post-CABG Patient - Outcome Experiences at Our Center - SVG to OM are More Likely to Develop Occlusion

Quality of Life After Percutaneous Coronary Intervention in No-Touch Saphenous Vein Grafts is Significantly Better Than in Conventional Vein Grafts.

ObjectiveTo compare health-related quality of life (HRQoL) of patients primarily treated with a no-touch saphenous vein graft with that of patients who received a conventional graft.MethodsThe study included all individuals treated with a percutaneous coronary intervention (PCI) on a saphenous vein graft (SVG) between January 2006 and June 2020. The RAND-36 health survey was used to assess HRQoL. The Mann-Whitney U test was used to test differences in HRQoL between the two groups. Effect size was estimated via Cohen’s d. The average treatment effect between the groups was tested by propensity score matching (PSM).ResultsOf the 346 patients treated with a PCI in a stenosed or occluded SVG, 165 responded to RAND-36 (no-touch: n=48; conventional: n=117). Patients with a no-touch graft reported better mean values on seven of the eight health survey domains. Statistically significant differences were observed for four of the domains, all in favour of the no-touch group. The effect size estimates indicated a small difference for five domains, with the highest values (>0.40) seen for the general health and energy/fatigue domains. PSM confirmed a statistically significant difference for the physical functioning and general health domains.ConclusionAt a mean follow-up of 5.4 years, patients who received a PCI in no-touch vein grafts showed significantly better HRQoL than those who received a PCI in conventional vein grafts.

Drug-Eluting versus Bare-Metal Stents in Saphenous Vein Grafts Compared to Native Coronary Vessels: The Norwegian Coronary Stent Trial Study

Background: Drug-eluting stents (DES) reduce target lesion revascularization (TLR) with no effect on mortality or myocardial infarction (MI) compared to bare-metal stents (BMS) in native vessels. Randomized stent studies in saphenous vein grafts (SVG) are few and the reported effects are ambiguous. The Norwegian Coronary Stent Trial study is the first to randomize lesions to percutaneous coronary intervention in native vessels and SVG. Aims: The aim of this study was to compare the rate of mortality, MI, and TLR across stent and vessel types. Methods: In this substudy, 6,087 patients with a single lesion in native vessels and 164 in SVG were followed for 5 years. Results: MI was more frequent in SVG (subdistributional hazard ratio [SHR] 4.95 (3.75–6.54, p < 0.001), but not affected by stent type. In the first 500 days, DES reduced TLR in native vessels (SHR 0.21 (0.15–0.30) p < 0.001) and SVG (SHR 0.18 (0.04–0.80) p = 0.02). Thereafter, DES and BMS were equivalent in native vessels, but DES had a higher TLR rate than BMS in SVG (SHR 3.31 (1.23–8.94) p = 0.02). After 5 years, the TLR rate was still significantly lower for DES in native vessels (3.2% vs. 7.8%, p < 0.001) but not in SVG (21.4% vs. 18. 4%). Conclusion: In SVG, no difference in TLR between DES and BMS was observed after 5 years in contrast to persistent benefit in native vessels. The high rate of TLR and MI in SVG makes treatment of native vessels a preference whenever feasible and better treatment options for SVG are warranted.

Percutaneous coronary intervention of totally occluded coronary venous bypass grafts: An exercise in futility?

BACKGROUNDPercutaneous coronary intervention (PCI) of diseased saphenous vein grafts (SVG) continues to pose a clinical challenge. Current PCI guidelines give a class III recommendation against performing PCI on chronically occluded SVG. However, contemporary outcomes after SVG intervention have incrementally improved with distal protection devices, intracoronary vasodilators, drug-eluting stents, and prolonged dual antiplatelet therapy. AIMTo reassess the procedural and long-term outcomes of PCI for totally occluded SVG with contemporary techniques.METHODSThis was a retrospective observational study conducted at a single university hospital. The study population consisted of 35 consecutive patients undergoing PCI of totally occluded SVG. Post-procedure dual antiplatelet therapy was continued for a minimum of one year and aspirin was continued indefinitely. Clinical outcomes were assessed at a mean follow-up of 1221 ± 1038 d. The primary outcome was freedom from a major adverse cardiac event (MACE) defined as the occurrence of any of the following: death, myocardial infarction, stroke, repeat bypass surgery, repeat PCI, or graft reocclusion. RESULTSThe study group included 29 men and 6 women with a mean age of 69 ± 12 years. Diabetes was present in 14 (40%) patients. All patients had Canadian Heart Classification class III or IV angina. Clinical presentation was an acute coronary syndrome in 34 (97%) patients. Mean SVG age was 12 ± 5 years. Estimated duration of occlusion was acute (< 24 h) in 34% of patients, subacute (> 24 h to 30 d) in 26%, and late (> 30 d) in 40%. PCI was initially successful in 29/35 SVG occlusions (83%). Total stent length was 52 ± 35 mm. Intraprocedural complications of distal embolization or no-reflow occurred in 6 (17%) patients. During longer term follow-up, MACE-free survival was only 30% at 3 years and 17% at 5 years.CONCLUSIONPCI of totally occluded SVG can be performed with a high procedural success rate. However, its clinical utility remains limited by poor follow-up outcomes.

Complications and failure modes of coronary embolic protection devices: Insights from the MAUDE database.

There is limited data on complications associated with the use of coronary embolic protection devices (EPDs). We queried the Manufacturer and User Facility Device Experience database between November 2010 and November 2020 for reports on coronary EPDs: Spider FX (Medtronic, Minneapolis, MN) and Filterwire EZ (Boston Scientific, Natick, MA). We retrieved 119 reports on coronary EPD failure (Spider FX n = 33 and Filterwire EZ n = 86), most of which (78.2%) occurred during saphenous vein graft interventions. The most common failure mode was inability to retrieve the EPD (49.6%), with the filter trapped against stent struts in 76.2% of the cases. Other device complications included filter fracture (28.6%), failure to cross (7.6%), failure to deploy (7.6%), and failure to recapture the filter (3.4%). Filter fracture (54.5 vs. 29.1%) and failure to recapture (9.1 vs. 2.1%) were more commonly reported, while failure to deploy the filter (0 vs. 10.5%) was less commonly reported with the Spider-FX. The most common modes of failure of coronary EPDs are the failure of retrieval (49.6%), followed by the filter fracture (28.6%). When using EPDs, careful attention to the technique is essential to avoid failures and subsequent complications.

When 7 times angioplasty on Saphenous Vein graft would not compete the Native vessel Percutaneous Coronary intervention

Coronary artery bypass graft (CABG) has been the first option for revascularization in multiple vessel coronary artery disease. One of the most major obstacles after CABGs is atherosclerotic changes of SVGand more than 50 percent ofSVGare occluded at 10 years and 25 percent show severe stenosis at angiographic follow-up. Whether native vessel percutaneous coronary intervention (PCI) on native vessel or saphenous vein graft intervention is of benefit in these patients is still a debate. In this case report we want to clarify a common clinical scenario in a patient with prior CABG seven years ago which a proper decision in the right time could save many futile efforts. The patient underwent 7 PCI on the diseased SVG on OM with frequent occlusion due to stent thrombosis and in-stent restenosis which finally native vessel antegrade CTO PCI alleviated the problem and patient followed up 2 months after the procedure without any chest pain in his ordinary activities.

Plateletcrit may predict no-reflow after saphenous vein graft interventions in patients with non-ST elevation myocardial infarction.

Saphenous vein graft (SVG) percutaneous coronary interventions (PCIs) are procedures with potential complications such as distal embolization, slow or no-reflow phenomenon. Platelets are the main factors in development of thrombus and no-reflow phenomenon. There have been multiple studies that identified the association between plateletcrit (PCT) and cardiovascular outcomes. The aim of the study was to investigate whether PCT can predict the development of no-reflow in patients with non-ST elevation myocardial infarction (NSTEMI) undergoing PCI for SVG disease. A total of 181 patients who underwent PCI for SVG disease with NSTEMI were included retrospectively. Platelet indices on admission were recorded. Patients were divided into two groups according to the development of no-reflow during the procedure: no-reflow (n = 32; 18%) and normal reflow (n = 149; 82%). PCT and platelet count were higher in the no-reflow group (0.254 vs. 0.224, P = 0.020; 265.4 vs. 233, P = 0.011, respectively). The PCT cut-off value for predicting no-reflow was calculated as 0.230 by ROC curve analysis with 68.8% sensitivity and 51.0% specificity. Multivariate logistic regression analysis showed that PCT was an independent predictor of no-reflow (odds ratio: 5.091, confidence interval: 1.356-19.116, P = 0.016). PCT may be useful in identifying patients at risk for developing no-reflow in patient with NSTEMI undergoing SVG PCI.

CHA2DS2-VASc score as a predictor of no-reflow phenomenon after saphenous vein graft percutaneous coronary intervention in patients with non-ST-segment elevation acute coronary syndromes.

Percutaneous coronary intervention (PCI) of saphenous vein grafts (SVGs) is associated with an increased risk of complications, particularly no‑reflow phenomenon and distal embolization due to low patency rates. The CHA2DS2‑VASc score is a clinical risk stratification tool used to predict thromboembolism events especially in patients with nonvalvular atrial fibrillation. The aim of this study was to investigate the relationship between the CHA2DS2‑VASc score and no‑reflow phenomenon after SVG PCI in patients with non-ST‑segment elevation acute coronary syndromes (NSTE‑ACS). In this study, we included 268 patients diagnosed with NSTE‑ACS who underwent PCI for SVG disease in our tertiary cardiovascular center. Patients were divided into 2 groups: group 1 without no‑‑reflow phenomenon (n = 190) and group 2 with no‑reflow phenomenon (n = 78) following the intervention, and then compared based on CHA2DS2‑VASc scores. The CHA2DS2‑VASc score (P <0.001) was significantly higher in group 2, even though no significant difference regarding atrial fibrillation was observed between the study groups. The CHA2DS2‑VASc score (P <0.001), degenerated saphenous vein graft (P = 0.006), and intraluminal thrombus (P <0.001) were found to be independent predictors of no‑reflow phenomenon. Receiver operating characteristics analysis showed that a CHA2DS2‑VASc score of 4 predicted no‑reflow phenomenon with 67.9% sensitivity and 69.3% specificity. Our findings suggest that the CHA2DS2‑VASc score can be an independent predictor of no‑reflow phenomenon in patients undergoing SVG interventions. As a simple and easy‑to‑calculate score, it might be a useful assessment tool to predict no‑reflow phenomenon before SVG interventions in patients with NSTE‑ACS.

Long-Term Clinical Outcomes of Percutaneous Coronary Intervention in Saphenous Vein Grafts in a Low to Middle-Income Country.

BackgroundRevascularization of saphenous vein grafts (SVGs) is challenging and debated for the last few decades. The percutaneous revascularization of SVGs was reported to have poorer long-term outcomes than native coronary artery revascularization.PurposeWe aim to study the peri-procedural complications and long-term outcomes of the percutaneous revascularization of SVGs in a low-middle-income country.MethodsIn this retrospective study, we included 110 patients who underwent percutaneous revascularization from January 2011 to March 2020 and followed them retrospectively for long-term outcomes and major adverse cardiovascular events.ResultsThe mean age was 71 ±9, and 81% were male. The most common reason for the presentation was non-ST segment elevation myocardial infarction (NSTEMI) (46%). The mean follow-up period of the study was 48±27 months. The most common comorbidity was hypertension (86%). A drug-eluting stent (80%) was placed in most of the patients, followed by a bare-metal stent (BMS) (14%) and percutaneous balloon angioplasty (POBA) (6%). We did not find any significant difference in major adverse cardiac events (MACE) (P=0.48), target vessel revascularization (TVR) (p=0.69), and target lesion revascularization (TLR) (p=0.54) with drug-eluting stent (DES) as compared to either BMS or POBA. The mean period from coronary artery bypass grafting (CABG) to SVG percutaneous coronary intervention (PCI) was 15± 5.5 years. Multivariate Cox regression analysis showed that an acute coronary syndrome (ACS) event, stroke, and female sex were independently associated with MACE.ConclusionThe long-term outcomes of SVG PCI are not affected by the types of stents. Female gender, ACS, and stroke are the independent predictors of MACE after SVG PCI, and statin therapy has a positive impact on the long-term outcomes of SVG PCI.