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| Intravascular Ultrasound Predictors of No-Reflow and Five-Year Clinical Outcomes after Stent Implantation for Saphenous Vein Graft Lesions |
| 1전남대학교병원 순환기내과, 2Cardiovascular Research Foundation, New York, New York, 3중앙대학교병원 순환기내과, 4인제의대 일산백병원 순환기내과, 5서울의료원 순환기내과, 6Cardiovascular Research Institute/Medstar Research Institute, Washington Hospital Center, Washington, DC |
| 홍영준1 , 정명호1, 안영근1, Gary S. Mintz2, 김상욱3, 이성윤4, 김석연5, Augusto D. Pichard6, Ron Waksman6, Neil J. Weissman6, 조정관1, 박종춘1, 강정채1 |
Background—Intravascular ultrasound (IVUS) predictors of no-reflow and relation between no-reflow and long-term clinical outcomes after stent implantation for saphenous vein graft (SVG) were not well known. The aim of this study was to investigate IVUS predictors of no-reflow and five-year clinical outcomes after stent implantation for SVG lesions
Methods and Results—We reviewed 311 patients who underwent IVUS-guided PCI for 311 SVG lesions. All patients were treated with stent implantation: 153 patients with sirolimus-eluting stents, 56 patients with paclitaxel-eluting stents, and 102 patients with bare-metal stents. No-reflow was defined as post-stenting TIMI grade 0, 1, or 2 flow. Of 311 patients who underwent pre- and post-stenting IVUS, no-reflow was observed in 39 patients (13%). Degenerated SVGs (62% versus 36%, P=0.002) and angiographic thrombus (41% versus 21%, P=0.006) were observed more frequently in the no-reflow group. IVUS-detected intraluminal mass (82% versus 43%, P<0.001), culprit lesion multiple plaque ruptures (23% versus 6%, P<0.001), and tissue prolapse (51% versus 35%, P=0.043) were significantly more common in patients with no-reflow. In the multivariate logistic regression analysis, an intraluminal mass (Hazard ratio [HR]=4.84; 95% CI 1.98-10.49, P=0.001), culprit lesion multiple plaque ruptures (HR=3.46; 95% CI 1.46-8.41, P=0.014), and degenerated SVGs (HR=3.17; 95% CI 1.17-6.56, P=0.024) were the independent predictors of post-PCI no-reflow. At five-year clinical follow-up, the rates of death [14 (36%) versus 55 (20%), P=0.036] and myocardial infarction [13 (33%) versus 52 (19%), P=0.039] were significantly higher in the no-reflow group. However, the rate of target vessel revascularization was not different significantly between two groups [15 (38%) versus 90 (33%), P=0.3].
Conclusions—IVUS-detected intraluminal mass, multiple plaque ruptures, and degenerated SVGs are associated with post-PCI no-reflow in SVG lesions. No-reflow was associated with poor long-term clinical outcomes after PCI for SVG lesions.
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