Predictors of outcome of percutaneous excimer laser coronary angioplasty of saphenous vein bypass graft lesions
A total of 495 patients underwent treatment with excimer laser angioplasty for 545 saphenous vein graft stenoses. Clinical success was achieved in 455 of 495 patients (92%), as indicated by ≤50% residual stenosis at every target lesion and no complication during hospitalization. At toast 1 in-hospital complication occurred in 30 of 495 patients (6.1%): death (1.0%), bypass surgery (0.6%), and Q-wave (2.4%) or non-Q-wave (2.2%) myocardial infarction. Relative risk analysis showed that ostial lesions (n = 65) tended to have higher clinical success (success rate = 95%, adjusted odds ratio [OR] = 2.1 [95% confidence interval (CI) 0.62, 6.88]; p = 0.24) and lower complications (complication rate = 0%, OR = 0.10 [CI 0.01, 0.79]; p = 0.03) than lesions in the body of the vein graft. Lesions >10 mm (n = 131) had lower success (success rate = 84%, OR = 0.30 [CI 0.16, 0.56]; p = 0.001) and higher complications (complication rate = 12%, OR = 3.3 [CI 1.6, 6.6]; p = 0.004) than discrete lesions. Lesions in small vein grafts <3.0 mm (n = 76) tended to have increased success (success rate = 94%, OR = 1.55 [CI 0.70, 3.44]; p = 0.39) and tower complications (complication rate = 2.2%, OR = 0.31 [CI 0.10, 0.94]; p = 0.03). Thus, excimer laser-facilrtated angioplasty has the most favorable outcome for discrete lesions located at the ostium of all grafts and in the body of smaller saphenous vein grafts. Comparison of excimer laser angioplasty with other treatments for these types of saphenous vein graft lesions is required to establish the clinical usefulness of excimer laser treatment. © 1994.
Bittl, JA; Sanborn, TA; Yardley, DE; Tcheng, JE; Isner, JM; Chokshi, SK; Strauss, BH; Abela, GS; Walter, PD; Schmidhofer, M; Power, JA; The Percutaneous Excimer Laser Coronary Angioplasty Registry,
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