Key result
SVG culprits during acute MI PCI linked to ~50% higher 1-year MACE versus native vessels.
Why the study?
Does PCI of a saphenous vein graft culprit compared to a native vessel culprit worsen outcomes in patients with acute myocardial infarction?
Cohort (n=4,193)
Does PCI of a saphenous vein graft culprit compared to a native vessel culprit worsen outcomes in patients with acute myocardial infarction?
In patients with acute myocardial infarction, a saphenous vein graft culprit lesion is associated with higher mortality and MACE compared to a native vessel culprit, despite smaller troponin elevations.
SVG culprit acute MI signals higher risk even with modest troponin rise; leaves open optimal management strategies.
OBJECTIVES: We sought to describe characteristics of patients presenting with an acute MI from a SVG culprit, compared with a native culprit. BACKGROUND: Percutaneous coronary intervention (PCI) of saphenous vein grafts (SVG) results in worse outcomes than native vessel PCI, but outcomes of such patients with acute myocardial infarction (MI) setting are not well-described. METHODS: Patients presenting with ST-elevation or non-ST-elevation MI undergoing PCI from 2000 to 2010 were retrospectively analyzed to identify the culprit as a SVG vs. native vessel. Multiple linear regression was used to identify predictors of peak troponin-I level. Cox proportional hazards regression was used to identify predictors of 30-day mortality and 1-year major adverse cardiac events (MACE). RESULTS: 192 patients underwent PCI for a SVG culprit, compared with 4,001 with a native culprit. After multivariable adjustment, SVG culprit remained significantly associated with lower levels of the logarithm of the peak troponin (β = -0.17, SE = 0.07, P = 0.02). The likelihood of MACE was higher in SVG vs. native culprits in patients with small to modest troponin elevations. Patients with a SVG culprit also suffered higher unadjusted rates of mortality at 30 days (14.3% vs. 8.4%, P = 0.03) and MACE at 1 year (36.8% vs. 24.5%, P = 0.005); a modest effect upon mortality and MACE remained after multivariable adjustment. CONCLUSION: Even minimal elevations of troponin in patients with a SVG culprit may portend a poorer prognosis than in patients with a native culprit. The risk of PCI in this setting is driven by mortality and arises from both substantial comorbidities and the SVG itself.
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Gaglia et al. (2010) conducted a cohort in Acute myocardial infarction (n=4,193). Saphenous vein graft (SVG) culprit vs. Native vessel culprit was evaluated on 1-year major adverse cardiac events (MACE) (p=0.005). A saphenous vein graft culprit in acute MI patients undergoing PCI was associated with higher unadjusted rates of 1-year MACE compared to a native vessel culprit (36.8% vs. 24.5%, P=0.005).
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