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

doi:10.4330/wjc.v13.i9.493

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Sep 26, 2021 (publication date) through Mar 2, 2025

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World Journal of Cardiology

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1949-8462

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Cardiol. Sep 26, 2021; 13(9): 493-502
Published online Sep 26, 2021. doi: 10.4330/wjc.v13.i9.493

Table 1 Patient characteristics

Characteristic	n = 35
Men	29 (83%)
Age (mean ± SD)	69 ± 12 yr
Hypertension	33 (94%)
Hyperlipidemia	25 (71%)
Diabetes	14 (40%)
Smoking	14 (40%)
Renal insufficiency	14 (40%)
History of CHF	6 (17%)
Prior MI	20 (57%)
Ejection fraction (mean ± SD)	43% ± 12%
Clinical presentation
STEMI	6 (17%)
NSTEMI	14 (40%)
Unstable angina	14 (40%)
Stable angina	1 (3%)
Canadian heart class
I, II	0
III	7 (20%)
IV	28 (80%)

CHF: Congestive heart failure; MI: Myocardial infarction; NSTEMI: Non-ST elevation myocardial infarction; SD: Standard deviation; STEMI: ST elevation myocardial infarction.

Table 2 Bypass graft characteristics

Characteristic	n (%)
SVG age (mean ± SD)	12.1 ± 5.1 yr
Prior PCI of SVG	10 (29)
Grafted native vessel
LAD	9 (26)
LCx	13 (37)
RCA	10 (29)
Multiple	3 (9)
Duration of graft occlusion
Acute (< 24 h)	12 (34)
Subacute (> 24 h to 30 d)	9 (26)
Late (> 30 d)	14 (40)

LAD: Left anterior descending; LCx: Left circumflex; m: mean; PCI: Percutaneous coronary intervention; SD: standard deviation; SVG: Saphenous vein graft.

Table 3 Procedural features and outcomes

Feature	n (%)
Anticoagulation
Heparin only	12 (34)
Bivalirudin	8 (23)
Heparin + GP IIb IIIa inhibitor	15 (43)
Thrombectomy	20 (57)
Distal protection device	9 (26)
Number of stents (mean ± SD)	2.1 ± 1.3
Total stent length (mean ± SD)	52 ± 35 mm
Stent type
Drug-eluting	19 (55)
Bare metal	11 (31)
None	5 (14)
Procedural outcome
Success	29 (83)
Failed	6 (17)
Procedural complications
Distal embolization	1 (3)
No reflow	5 (15)
In-hospital MACE
Death	2 (5.7)
Myocardial infarction	1 (2.9)
Stroke	0
Repeat PCI or CABG	0
Any MACE	3 (8.6)

CABG: Coronary artery bypass grafting; GP: Glycoprotein; m: mean; MACE: Major adverse cardiac event; SD: Standard deviation.

Table 4 Follow-up major adverse cardiac event

MACE type	n (%)
Death	5 (14)
Stroke	1 (3)
MI	15 (43)
Repeat bypass surgery	0
Repeat PCI	6 (17)
Graft reocclusionAny MACE	7 (20) 28 (80)

MACE: Major adverse cardiac event; MI: Myocardial infarction; PCI: Percutaneous coronary intervention.

Citation: Nardone EW, Madsen BM, McCarey MM, Fischman DL, Ruggiero NJ, Walinsky P, Vishnevsky A, Savage MP. Percutaneous coronary intervention of totally occluded coronary venous bypass grafts: An exercise in futility? World J Cardiol 2021; 13(9): 493-502
URL: https://www.wjgnet.com/1949-8462/full/v13/i9/493.htm
DOI: https://dx.doi.org/10.4330/wjc.v13.i9.493