Key result
PCI in no-touch SVGs linked to ~84% less long-term in-stent restenosis vs. conventional grafts.
Why the study?
Conventional vein grafts have a high risk of thrombosis and early atherosclerosis, and PCI in these grafts is associated with higher late adverse cardiac events, motivating evaluation of long-term outcomes after PCI in no-touch versus conventional vein grafts.
Does PCI in no-touch saphenous vein grafts reduce long-term in-stent restenosis compared to conventional vein grafts in patients with prior CABG?
Cohort (n=346)
No
Does PCI in no-touch saphenous vein grafts reduce long-term in-stent restenosis compared to conventional vein grafts in patients with prior CABG?
Hazard Ratio: 0.16
Absolute Event Rate: 3.2% vs 18.7%
p-value: p=0.010
PCI in saphenous vein grafts harvested with the no-touch technique is associated with significantly lower rates of long-term in-stent restenosis and MACE compared to conventional grafts.
No-touch SVG PCI was associated with fewer long-term restenoses and MACE; leaves open whether this warrants preferential no-touch harvesting.
Introduction Conventional vein grafts have a high risk of thrombosis and early atherosclerosis. Percutaneous coronary intervention (PCI) in conventional vein grafts is associated with a higher incidence of late adverse cardiac events. The aim of this study was to evaluate the long-term results after PCI in saphenous vein grafts (SVG) harvested with the no-touch technique compared to the conventional technique. Methods This was a single-center, retrospective, cohort study, based on data from the Swedeheart register. The inclusion criterion was individuals who underwent CABG using different vein graft techniques between January 1992 and July 2020, and who required a PCI in SVGs between January 2006 and July 2020. The primary end point was long-term in-stent restenosis. The secondary endpoints were long-term major adverse cardiac events (MACE) and 1-year re-hospitalization rates. The associations between the graft types and the endpoints were evaluated using the Fine and Gray competing-risk regression analysis. Results The study included 346 individuals (67 no-touch, 279 conventional). The mean clinical follow-up time was 6.4 years with a standard deviation of 3.7 years. The long-term in-stent restenosis rate for the no-touch grafts was 3.2% compared to 18.7% for the conventional grafts ( p < .01), with a subdistribution hazard ratio (SHR) of 0.16 ( p = .010). The long-term MACE rate was 27.0% in the no-touch group and 48.3% in the conventional group ( p < .01) with a SHR of 0.53 ( p = .017). The short-term results were similar in both groups. Conclusions Percutaneous coronary intervention in a no-touch vein graft was associated with statistically significantly fewer in-stent restenoses and MACE at long-term follow-up compared to a conventional SVG.
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Ferrari et al. (2024) conducted a cohort in Prior CABG requiring subsequent PCI in saphenous vein grafts (n=346). No-touch saphenous vein grafts vs. Conventional saphenous vein grafts was evaluated on Long-term in-stent restenosis (SHR 0.16, p=0.010). PCI in no-touch saphenous vein grafts was associated with significantly lower long-term in-stent restenosis compared to conventional grafts (3.2% vs 18.7%; SHR 0.16, p=0.010).
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