Clinical outcomes after successful percutaneous coronary angioplasty of saphenous vein graft disease and the importance of long-term assessment

We examined the short- and long-term outcome of 327 patients at Mayo Clinic who had undergone coronary angioplasty of saphenous vein graft stenoses to determine whether the traditional 6-month assessment of clinical end points after coronary angioplasty is as useful as it is for patients who have had angioplasty of native vessel disease. Follow-up over 3.3±2.7 years was performed. At 6 months, 96±1% of the patients were alive, whereas at the 1- and 5-year end points, survival had deteriorated to 92±2 and 67±3%, respectively. Only 80±2% were free of severe angina at 6 months and 62±3 and 36±3% after 1 and 5 years. Combined event-free rate for death, Q-wave myocardial infarction or repeat coronary artery bypass surgery was 86±2% at 6 months, 78±2% at 1 year, and 45±4% at 5 years. Independent predictors of mortality included advancing age, diabetes mellitus, target vein grafts >5 years old and left ventricular ejection fraction <40%. In conclusion, despite reasonable 6- to 12-month outcomes following vein graft angioplasty, significant attrition in survival and event-free survival was observed. These observations have important implications for the interpretation of results of trials comparing conventional angioplasty and coronary bypass surgery with newer interventional devices if only the traditional 6-month follow-up interval is used.