Impact of lesion location on intravascular ultrasound findings and short-term and five-year long-term clinical outcome after percutaneous coronary intervention for saphenous vein graft lesions

BackgroundLittle is known about intravascular ultrasound (IVUS) findings and acute post-percutaneous coronary intervention (PCI) outcome and long-term clinical outcome between aorto-ostial lesion and shaft lesion after PCI for saphenous vein graft (SVG) lesions.MethodsAorto-ostial lesion was defined as those arising within 3 mm of the origin of SVG and shaft lesion was defined as those arising in remaining portion of SVG. We evaluated pre- and post-PCI IVUS images of 311 SVG lesions and compared IVUS findings and acute post-PCI outcome and 5-year clinical outcome between aorto-ostial lesion (n = 64) and shaft lesion (n = 247).ResultsThe presence of positive remodeling (40% vs. 22%, p = 0.026), hypoechoic plaque (47% vs. 36%, p = 0.035), plaque rupture (23% vs. 8%, p = 0.008), multiple plaque rupture (9% vs. 2%, p = 0.038), and an intraluminal mass (54% vs. 25%, p < 0.001) were significantly more common in shaft lesion than in aorto-ostial lesion. Post-PCI no-reflow (15% vs. 5%, p = 0.033), post-PCI tissue prolapse (TP) (40% vs. 23%, p = 0.014), and post-PCI creatine kinase-MB elevation more than 3 times normal (14% vs. 8%, p = 0.047) were observed more frequently after PCI for shaft lesion than for aorto-ostial lesion. At 5-year clinical follow-up, the incidences of death (25% vs. 13%, p = 0.036) and myocardial infarction (24% vs. 11%, p = 0.028), but not the rate of target vessel revascularization (36% vs. 25%, p = 0.096), were significantly higher in patients with shaft lesion compared with those with aorto-ostial lesion.ConclusionsSVG shaft lesion has more unstable plaque morphology and this may contribute to the worse acute PCI outcomes and long-term outcomes.