The Prognostic Impact of Saphenous Vein Graft in Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Patients

Background: Patients treated with primary percutaneous coronary intervention (pPCI) for ST elevation myocardial infarction (STEMI) who have a history of coronary artery bypass grafting (CABG) are at high risk of adverse cardiovascular outcomes. Data on the risk of a saphenous vein graft (SVG) - infarct related artery (IRA) compared to other culprit vessels are sparse.

Methods: The study was based on a prospectively collected registry of 2405 consecutive patients with STEMI attending a tertiary medical center in 2001-2017. Patients with an SVG-IRA (n=172) were compared with patients with native vessel disease (n=2333) for mortality and major adverse cardiac events (MACE), which included death, myocardial infarction (MI), target vessel revascularization (TVR), and coronary artery bypass surgery (CABG) at 1 month and 3 years.

Results: The SVG-IRA group was significantly older than the native vessel group (p=0.05), with no between-group differences in rates of male patients (76% vs. 82%, p=0.59), diabetes (24.2% vs 26.2%, p=0.73), and renal failure (18.8% vs. 9.2%, p=0.25). Mortality was higher in the SVG-IRA group at 1 month (13.9% vs. 2.5%, P <0.01) and 3 years (23.9% vs. 7.4%, p <0.01). At 3 years, SVG-IRA was associated with the highest rates of MACE (55.6%), compared with native vessel disease. After correction for confounders, SVG-IRA remained an independent risk factor for MACE both at 1 month (HR- 2.08, 95%CI 1.72-3.11, p <0.01) and 3 years (HR- 2.01, 95%CI 1.28-3.09, p <0.01).
Conclusion: Among patients treated with pPCI for STEMI, outcomes are worse when the culprit is an SVG.