Immediate and Long-Term Results of Drug-Eluting Stents in Mammary Artery Grafts

doi:10.1016/j.amjcard.2015.08.040

The American Journal of Cardiology

Volume 116, Issue 11, 1 December 2015, Pages 1695-1699

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Percutaneous intervention of a coronary graft is the treatment of choice when the graft fails. The objective is to report the long-term results of drug-eluting stents (DES) in mammary artery grafts (MAG). Patients who had been treated with DES for MAG in 27 centers were selected. The baseline and procedural clinical data were included prospectively, and the follow-up was performed with the patients, families, and medical records. Two hundred and sixty-eight patients were included: age 65.5 ± 10.1 years, diabetes 47.8%, ejection fraction 55.5 ± 14.9%. Indication: stable angina 28.4%, unstable angina 38.1%, non–ST-elevation myocardial infarction 21.6%, ST-elevation myocardial infarction 5.3%, and heart failure 6.7%; 1.19 ± 0.59 stents/patient were implanted measuring 18.8 ± 8.8 mm in length and 2.68 ± 0.35 mm in diameter. Rapamycin was used in 78 cases (29.1%), paclitaxel in 77 (28.7%), everolimus in 70 (26.1%), zotarolimus in 34 (12.7%), and biolimus in 9 (3.4%). All cases were successful except for 1 in which the patient died 30 minutes after the procedure. There were no other inhospital events. After a follow-up of 41 months (Q₂₅: 23.7 to Q₇₅: 57.8), 24 patients (9%) died of heart-related causes and 20 (7.5%) of noncardiac causes. Repeat revascularization was necessary in 31 cases, and in 1 additional patient, there was total occlusion, which was not treated. These 32 patients represented 11.9% of the total. In conclusion, the implantation of DES in MAG shows very high procedural success and also low long-term event rates.

Section snippets

Methods

An observational study of a cohort of patients treated consecutively with at least 1 DES in a lesion affecting an MAG. Twenty-seven centers were contacted in Spain to obtain the data of patients treated from 2003 to 2011.

We selected all the patients who had received at least 1 DES in an MAG on the date indicated from 27 centers in Spain. The clinical and procedural characteristics had been introduced prospectively at the time of PCI. The data relating to follow-up were obtained from the medical

Results

A total of 268 patients aged 65.5 ± 10.1 years was included. Table 1 provides the patient characteristics and Table 2 provides the characteristics of the lesions and the data relating to the procedure. None of the patients had 2 different types of DES.

The procedure was successful in 263 patients (98.2%), whereas in 1 case, there was final Thrombolysis In Myocardial Infarction (TIMI) flow grade 0, in 2 cases TIMI flow grade 1, and in another 2 TIMI flow grade 2. The TIMI 0 patient died half an

Discussion

Existing data on DESs in MAG are scarce, and they are limited to clinical case reports or studies on a small number of patients. Our study represents the largest series of patients with implantation of DESs in MAG.

Although current literature on these devices in saphenous veins is very detailed, the results cannot be extrapolated to MAG because of their different characteristics. Therefore, although the latter only measure 1.9 to 2.6 mm in diameter, compared with the 3.1 to 8.5 mm of the venous

Disclosures

Dr. de la Torre is a consultant of Abbott, Boston Scientific, Biotronik, Volcano, Medtronic, IHT, Astra, and Lilly. None of the other authors have any conflict of interest.

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Cited by (6)

Characteristics of Radial Artery Coronary Bypass Graft Failure and Outcomes Following Subsequent Percutaneous Coronary Intervention
2023, JACC: Cardiovascular Interventions
When patients with prior coronary artery bypass grafting (CABG) undergo percutaneous coronary intervention (PCI), targeting the native vessel is preferred. Studies informing such recommendations are based predominantly on saphenous vein graft (SVG) PCI. There are few data regarding arterial graft intervention, particularly to a radial artery (RA) graft.
The aim of this study was to report the characteristics of arterial graft stenoses and evaluate the feasibility of RA PCI.
This study included 2,780 consecutive patients with prior CABG undergoing PCI between 2005 and 2018 who were prospectively enrolled in the MIG (Melbourne Interventional Group) registry. Data were stratified by PCI target vessel. RA graft PCI was compared with both native vessel (native PCI) and SVG PCI. Internal mammary graft PCI data were reported. The primary outcome was 3-year mortality.
Overall, 1,928 patients (69.4%) underwent native PCI, 716 (25.6%) SVG PCI, 86 (3.1%) RA PCI, and 50 (1.8%) internal mammary graft PCI. Compared with SVG PCI, the RA PCI cohort presented earlier after CABG, less frequently had acute coronary syndrome, and more commonly had ostial or distal anastomosis intervention (P < 0.005 for all). Compared with patients who underwent native PCI, those who underwent RA PCI were more likely to have diabetes and peripheral vascular disease (P < 0.001 for both) and to present with non–ST-segment elevation myocardial infarction (P = 0.010). The RA PCI group had no perforations or in-hospital myocardial infarctions, though no significant difference was found in periprocedural outcomes compared with either native or SVG PCI. No differences were found between RA PCI and either native or SVG PCI in 30-day outcomes or 3-year mortality.
Presenting and lesion characteristics differed between patients undergoing arterial compared with SVG PCI, implying a varied pathogenesis of graft stenosis. RA PCI appears feasible, safe, and where anatomically suitable, may be a viable alternative to native PCI.
Internal mammary artery graft failure: Clinical features, management, and long-term outcomes
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Citation Excerpt :
Currently, DES has been deemed to be the first choice because its lower rates of in stent restenosis, compared with BMS.19,20 Recently, a 27-center registry by Lozano et al on the use of DES in 268 patients with a failed mammary graft, reported good long-term results.21 This report only included patients who had already received, at least, a DES in the IMA graft.
Data on long-term outcomes after internal mammary artery (IMA) coronary graft failure are scarce. Our objective was to describe the clinical characteristics, management, and prognosis after angiographically confirmed IMA graft failure following coronary revascularization.
A three-hospital retrospective registry, observational and descriptive, with prospective follow-up of all consecutive cases of IMA graft failure between 2004 and 2014 was conducted. After treatment, clinical and procedural features were compared between those with and without cardiovascular events.
Fifty-seven patients were included (89% male, mean age: 62 years, at surgery) in the registry. Most patients underwent an IMA angioplasty (percutaneous coronary intervention [PCI], 74%). In nine cases, the PCI failed at the graft level, and seven underwent a native vessel revascularization. Native vessel treatment was performed in 20% of the study subjects, all with stents. Finally, medical management was decided in three cases. Events after treatment for IMA graft failure were frequent (50.8%), during a median follow-up of 7.5 years. Acute presentation (hazard ratio_MACE = 1.35; 95% confidence interval (CI): 1.12–3.00, p < 0.01), age of the patient (hazard ratio_MACE = 1.85, 95% CI: 1.17–2.11, p < 0.01), presence of diabetes mellitus (hazard ratio_MACE = 2.75, 95% CI: 1.13–6.69, p = 0.02), and the management modality used (IMA-simple angioplasty VS IMA-stenting: hazard ratio_MACE = 5.5, 95% CI: 1.40–21.15, p = 0.01) displayed prognostic relevance on multivariate analysis. All-cause mortality occurred in 21.1% and presentation as infarction (hazard ratio_DEATH = 1.05, 95% CI: 1.01–2.17, p = 0.01), age (hazard ratio_DEATH = 9.08, 95% CI: 2.52–32.69, p < 0.01), and left ventricular ejection fraction (hazard ratio_DEATH = 3.68, 95% CI: 1.65–8.18, p < 0.01) were independent predictors of the same.
In this long-term registry, most patients presented with an acute condition (myocardial infarction, progressive angina) within 12 months after surgery. Acute presentation, age, diabetes mellitus, reduced left ventricular ejection fraction, IMA graft failure segment affected, and the management strategy were related with long-term prognosis.
Long-term outcomes of percutaneous revascularization for internal mammary artery–left anterior descending artery bypass failure
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Therapeutic effects of the novel Leucyl-tRNA synthetase inhibitor BC-LI-0186 in non-small cell lung cancer
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Pathology of stent implantation in internal mammary artery
2019, Cardiovascular Intervention and Therapeutics
How should i treat a des restenosis in a graft anastomosis with challenging access and multiple previous coronary interventions?
2016, EuroIntervention

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Coronary Artery DiseaseImmediate and Long-Term Results of Drug-Eluting Stents in Mammary Artery Grafts

Section snippets

Methods

Results

Discussion

Disclosures

Am J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Am J Cardiol

Lancet

Lancet

J Am Coll Cardiol

Ann Thorac Surg

Arch Cardiovasc Dis

Eur Heart J

Coronary Artery Disease
Immediate and Long-Term Results of Drug-Eluting Stents in Mammary Artery Grafts