Angiographic and clinical outcomes following acute infarct angioplasty on saphenous vein grafts

Abstract

Acute infarct angioplasty on aortocoronary saphenous vein grafts (SVGs) poses significant challenges because of their degenerate morphology and presence of significant thrombus. Of 370 acute, primary, or rescue myocardial infarct angioplasties performed over 3 years, 21 (5.7%) were on SVGs in patients who had undergone previous coronary artery bypass grafting a mean of 7.2 years earlier. Mean duration of chest pain to start of intervention was 3.9 +/- 3.2 hours; 6 (29%) patients presented with cardiac shock and 4 had failed treatment with thrombolytic drugs. At intervention, 11 (52%) of the culprit SVGs were totally occluded. Flow was reestablished or improved in 18 (86%), but classified as Thrombolysis In Myocardial Infarction trial grade 3 in only 10 patients (48%). Distal embolization and "no reflow" occurred with a frequency of 57% and 71%, respectively. In-hospital mortality was 19%. At 6 months, freedom from death, repeat target vessel revascularization, or recurrent myocardial infarction was 55%. In 349 patients undergoing native vessel intervention, success and Thrombolysis In Myocardial Infarction trial 3 flow rates were seen in 95% and 73% of patients, respectively, and in-hospital mortality was 7.9%. This present study demonstrates that infarct angioplasty on culprit SVGs can be successful but is associated with higher rates of embolic complications and worse acute and long-term clinical outcomes compared with a parallel experience of acute infarct angioplasty on native coronary arteries.