Turk Kardiyol Dern Ars. 2010; 38(8): 531-536

Efficacy and outcome of primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction due to saphenous vein graft occlusion

Mehmet Ergelen¹, Hüseyin Uyarel², Mehmet Gül¹, Ayça Türer¹, Ersin Yıldırım¹, Mehmet Bozbay¹, Deniz Demirci¹, Duygu Ersan¹, Ceyhan Türkkan¹, Mahmut Uluganyan¹, Tuna Tezel^1
1Department of Cardiology, Siyami Ersek Cardiovascular And Thoracic Surgery Center, Istanbul, Turkey
²Balıkesir University Faculty of Medicine, Department of Cardiology, Balıkesir, Turkey

OBJECTIVES
We evaluated the efficacy and outcome of primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) due to saphenous vein graft (SVG) occlusion.

STUDY DESIGN
We reviewed 2,646 consecutive patients (mean age 56.6±11.8 years) who underwent primary PCI for STEMI between 2003 and 2009. All clinical and angiographic data and in-hospital and long-term (median 22 months) outcomes were retrospectively collected. The patients were classified into two groups based on the lesions treated with primary PCI, i.e., native vessels (n=2,625) and SVG (n=21).

RESULTS
Compared to patients with occluded native vessels, patients with SVG occlusion had significantly higher rates of coronary bypass operation (100% vs. 2.3%, p<0.001), previous myocardial infarction (52.4% vs. 10.8%, p<0.001), and diabetes mellitus (52.4% vs. 25.1%, p=0.002), but lower frequency of anterior myocardial infarction (9.5% vs. 49.3%, p<0.001). Tirofiban use (71.4% vs. 48.2%, p=0.01) and three-vessel disease (81% vs. 25.6%, p<0.001) were significantly more common in the SVG group. The rate of successful primary PCI was lower in SVG occlusions compared to native vessels (61.9% vs. 84.7%, p=0.01). The two groups did not differ significantly with respect to in-hospital and long-term cardiovascular events and mortality (p>0.05). In multivariate logistic regression analysis, application of PCI to SVG was found to be an independent predictor for unsuccessful procedure (OR 6.76, 95% CI 2.05-22.21; p=0.002).

CONCLUSION
Although the success rate of primary PCI in SVG lesions was lower compared to native vessels, this did not have an adverse effect on postprocedural cardiovascular events and mortality in patients presenting with STEMI.

Keywords: Angioplasty, balloon, coronary, coronary angiography; coronary artery bypass; graft occlusion, vascular; myocardial infarction; saphenous vein/transplantation

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