Key result
In STEMI patients undergoing pPCI, a saphenous vein graft culprit increased the 3-year risk of MACE compared to native vessel disease (HR 2.01; 95% CI 1.28-3.09; p<0.01).
Why the study?
Data comparing the risk of a saphenous vein graft infarct-related artery to other culprit vessels in patients undergoing primary PCI for STEMI were sparse.
Does primary PCI of a saphenous vein graft culprit compared to native vessel disease worsen outcomes in patients with STEMI?
Cohort (n=2,405)
No
Does primary PCI of a saphenous vein graft culprit compared to native vessel disease worsen outcomes in patients with STEMI?
Hazard Ratio: 2.01 (95% CI 1.28–3.09)
p-value: p=<0.01
In patients undergoing primary PCI for STEMI, having a saphenous vein graft as the culprit vessel is associated with significantly higher mortality and MACE compared to native vessel disease.
Raises caution for SVG culprits in STEMI pPCI; leaves open optimal management strategies.
BACKGROUND: Patients treated with primary percutaneous coronary intervention (pPCI) for ST elevation myocardial infarction (STEMI) who have a history of coronary artery bypass grafting (CABG) are at high risk of adverse cardiovascular outcomes. Data on the risk of a saphenous vein graft (SVG)-infarct-related artery (IRA) compared to other culprit vessels are sparse. METHODS: The study was based on a prospectively collected registry of 2,405 consecutive patients with STEMI attending a tertiary medical center in 2001-2017. Patients with an SVG-IRA (n = 172) were compared with patients with native vessel disease (n = 2,333) for mortality and major adverse cardiac events (MACE), which included death, myocardial infarction (MI), target vessel revascularization (TVR), and coronary artery bypass surgery (CABG) at 1 month and 3 years. RESULTS: The SVG-IRA group was significantly older than the native vessel group (p = .05), with no between-group differences in rates of male patients (76 vs. 82%, p = .59), diabetes (24.2 vs. 26.2%, p = .73), and renal failure (18.8 vs. 9.2%, p = .25). Mortality was higher in the SVG-IRA group at 1 month (13.9 vs. 2.5%, p < .01) and 3 years (23.9 vs. 7.4%, p < .01). At 3 years, SVG-IRA was associated with the highest rates of MACE (55.6%), compared with native vessel disease. After correction for confounders, SVG-IRA remained an independent risk factor for MACE both at 1 month (HR-2.08, 95%CI 1.72-3.11, p < .01) and 3 years (HR-2.01, 95%CI 1.28-3.09, p < .01). CONCLUSION: Among patients treated with pPCI for STEMI, outcomes are worse when the culprit is an SVG.
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Kheifets et al. (2019) conducted a cohort in ST elevation myocardial infarction (STEMI) (n=2,405). Saphenous vein graft (SVG) culprit vs. Native vessel disease was evaluated on Major adverse cardiac events (MACE) at 3 years (HR 2.01, 95% CI 1.28-3.09, p=<0.01). In STEMI patients undergoing pPCI, a saphenous vein graft culprit increased the 3-year risk of MACE compared to native vessel disease (HR 2.01; 95% CI 1.28-3.09; p<0.01).
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