Search

The impact of the progress of interventional cardiology on the improved prognosis of myocardial infarction due to occlusion of a saphenous vein bypass graft is not well known. The aim of this study was to report the modalities and results at short and medium term of revascularisation by angioplasty of venous grafts in the acute phase of myocardial infarction. Out of a total of 870 consecutive patients treated by angioplasty in the first 6 hours of myocardial infarction with persistent ST elevation between 1990 and 2002, 16 (2%) had acute occlusion of a saphenous vein graft. Twelve of the 16 patients had previous myocardial infarction; perfusion was obtained in 7 patients. The attempt failed in 9 patients because of "no-reflow" (n=5), the extensive nature of the thrombosis (n=2) and technical failure (n=2). Three patients died in hospital, all after failed angioplasty. At 6 months, of the 13 survivors of the hospital period, 2 had been readmitted for a revascularisation procedure. At 2 years, 3 patients had died, 2 were readmitted for recurrent myocardial infarction and 8 patients remained free of a major cardiovascular event. Reperfusion by angioplasty of an occluded saphenous vein graft in the acute phase of myocardial infarction remains imperfect and the prognosis at short and medium term is poor.

Objective: To examine the outcome of intracoronary stent placement by 'primary intention', guided by angiography alone, and without the use of postprocedural anticoagulation., Design: Prospective, observational study., Setting: Canadian university teaching hospital., Patients: Patients (n=559) undergoing urgent or elective percutaneous revascularization procedures (n=616) in whom a preprocedural decision to employ coronary stent placement was made. Emergency and bailout stent procedures were excluded., Intervention: Stents were delivered at high pressure (1616 to 1818 kPa) on balloons matched to the proximal reference segment diameter. Adequacy of stent deployment was judged by angiographic criteria alone. Postprocedural medication included acetylsalicylic acid and ticlopidine. Quantitative coronary angiographic analysis was independently performed. Acute procedural outcomes were prospectively collected. Patients were followed for one year., Results: All but one patient had a successful angiographic result. Periprocedural death (0.3%), Q wave myocardial infarction (MI) (0%), non-Q MI (1.6%) and stent thrombosis (0.6%) were uncommon events. At one year, 96% of patients were alive and free of MI, while 12% of patients required repeat target lesion revascularization., Conclusion: A primary intention strategy of intracoronary stenting, guided by angiography alone, is a safe and effective approach to percutaneous coronary revascularization.