Are we making progress with percutaneous saphenous vein graft treatment? Acomparison of 1990 to 1994 and 1995 to 1998 results

Objectives We sought to determine whether strategies to reduce procedural d istal embolization and late repeat revascularization have resulted in more favorable outcomes after saphenous vein graft (SVG) angioplasty. Background Angioplasty of SVG lesions has been associated with frequent pro cedural and late cardiac events. Therefore, evolving strategies have been a ttempted to improve outcomes after SVG angioplasty. Methods We compared our earlier experience (1990 to 1994) cf 1,055 patients with 1,412 SVG lesions with a recent group (1995 to 1998) of 964 patients with 1,315 lesions. Results Baseline characteristics were similar between the groups. However, there were significantly more unfavorable lesion characteristics (older, lo nger and significantly more degenerated SVGs) in the recent series. Between the two periods, there was decreased use of atheroablative devices, wherea s stent use increased. The procedural success rates (96.6% vs. 96.1%) were similar. However, one-year outcome (event-free survival) was significantly improved in the more recent experience (70.7% vs. 59.1%, p < 0.0001), espec ially late mortality (6.1% vs. 11.3%, p < 0.0001). Multivariate analysis sh owed stc:nt use to be the only protective variable for both periods. Conclusions This study shows that despite higher risk lesions, strategies t o reduce distal embolization have maintained high procedural success. Late cardiac events, including mortality have also been substantially reduced. ( J Am Coll Cardiol 2001;38:150-4) (C) 2001 by the American College of Cardio logy.