Long-term clinical outcome after stent implantation in saphenous vein grafts

Objectives. We sought to determine the role of stent implantation in vein grafts by evaluating the long-term clinical outcome and estimated event-free survival at 5 years in 62 patients and by comparing our dat with those of other treatment modalities previously reported. Background. Patients with recurrent angin after coronary artery bypass graft surgery pose problem. Stent implantation has been advocated in an effort to avoid repeat operation and to address the limitations of balloon angioplasty. Methods. Patients undergoing stenting of vein graft were entered into dedicated dat base. They were screened for death, infarction, bypass surgery and repeat angioplasty. Procedure-related events were included in the follow-up analysis. Survival and event-free survival curves were constructed by the Kaplan-Meier method. Results. total of 93 stents (84 Wallstent and 9 Palmaz-Schatz) were implanted in 62 patients. During the in-hospital period, seven patients (11%) sustained major cardiac event: two deaths (3%), two myocardial infarctions (3%) and three argent bypass surgeries (5%). The clinical success rate, therefore, was 89%. During the follow-up period (median 2.5 years, range 0 to 5.9), another five patients (8%) died, 14 (23%) sustained myocardial infarction, 12 (20%) underwent bypass surgery, and 14 (23%) underwent angioplasty. The estimated 5-year survival and event-free survival rates (free from infarction, repeat surgery and repeat angioplasty) were (mean ± SD) 83 ± 5% (95% confidence interval [CI] 73% to 93%) and 30 ± 7% (95% CI 16% to 44%), respectively. Conclusions. The in-hospital outcome of patients who underwent stent implantation in vein graft is acceptable, but the long-term clinical outcome is poor. It is unlikely that mechanical intervention alone will provide satisfactory or definite answer for the patient with graft sclerosis over the long term.