SCAAR Registry: Coronary Angioplasty in Venous Grafts

Most patients undergoing coronary artery bypass graft (CABG) benefit from at least one saphenous vein graft (SVG). It is well known that SVG degeneration and severe stenosis are frequent, making it impossible for patients to undergo native artery PCI and therefore recurring to SVG PCI.  

Several prior studies have shown PCI outcomes tend to be better when done on native arteries vs. SVG PCI. 

However, there is still no research on SVG PCI with modern stents, which have better evolution in the real world. 

The SCAAR registry showed 2,198 patients undergoing CABG, presenting severe de novo lesion to a SVG. 2,190 of these patients (58.7%) received SVG stenting while the rest received multiple stents including SVG stenting and, in some cases, also native artery stenting. 

Study groups presented similar characteristics: mean age was 74, 14% were women, 22% had insulin dependent diabetes mellitus, and 18% non-dependent. Also, 92% had hypertension, 91% dyslipidemia, 65% were smokers,69% had suffered MI and 45% had prior PCI. 

Read also: Long Term Outcomes of RIBS VI, a Study on Bioresorbable Stents in Patients with In-Stent Restenosis.

50% of patients were admitted with acute non-ST elevation MI (NSTEMI). 22% with stable chronic angina and in lower proportion with ST elevation MI (STEMI), stable chromic angina and silent ischemia. 

The transradial approach was used in half of patients. 50% of SVG PCI procedures were to the circumflex, 38% to the right coronary, and 22% to the anterior descending. Procedural success rate was 98.3%.

At one and three-year follow-up, there were no significant differences in mortality (9.2% and 19.8%, respectively), MI (9.1% and 21.1%), target lesion revascularization (TLR) (4.3% and 13.6%), stent thrombosis (1.2% and 2.9%) or restenosis (4.3% y 10.8%).

Conclusion

In this registry, patients undergoing SVG PCI with last generation drug eluting stents presented high risk characteristics and high rate of adverse clinical events. However, there was a low incidence of events specifically related to stenting or target lesions. 

Original Title: Outcome of Saphenous Vein Graft Percutaneous Coronary Intervention Using Contemporary Drug-Eluting Stents: A SCAAR Report.

Reference: Saman Saidi-Seresht, et al. JSCAIhttps://doi.org/10.1016/j.jscai.2024.102232. Article in press.