In vivo morphologic comparison of saphenous vein grafts and native coronary arteries following non-ST elevation myocardial infarction |
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Authors: | Tom Hsun-Wei Huang Kalpa De Silva Usaid K Allahwala Edward J Danson Pasi K Karjalainen Olli A Kajander Ravinay Bhindi |
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Institution: | 1. Sydney Medical School, Faculty of Medicine, The University of Sydney, Camperdown, NSW, Australia;2. Department of Cardiology, Royal North Shore Hospital, Sydney, Australia;3. Bristol Heart Institute, Bristol Royal Infirmary, UK;4. Department of Cardiology, Wollongong Hospital, NSW, Australia;5. Heart Center, Satakunta Central Hospital, Pori, Finland;6. Heart Hospital, Tampere University Hospital and Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland |
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Abstract: | ObjectiveThis study aimed to assess the pathophysiological differences between saphenous vein grafts (SVG) and native coronary arteries (NCA) following presentation with non-ST elevated myocardial infarction (NSTEMI).BackgroundThere is accelerated pathogenesis of de novo coronary disease in harvested SVG following coronary artery bypass (CABG) surgery, which contributes to both early and late graft failure, and is also causal in adverse outcomes following vein graft PCI. However in vivo assessment, with OCT imaging, comparing the differences between vein grafts and NCAs has not previously been performed.MethodsWe performed a retrospective, observational, analysis in patients who underwent PCI with adjunctive OCT imaging following presentation with NSTEMI, where the infarct-related artery (IRA) was either in an SVG or NCA.ResultsA total of 1550 OCT segments was analysed from thirty patients with a mean age of 66.3 (±9.0) years were included. The mean graft age of 13.9 (±5.6) years in the SVG group. OCT imaging showed that the SVG group had evidence of increased lipid pool burden (lipid pool quadrants, 2.1 vs 2.7; p?=?0.021), with a reduced fibro-atheroma cap-thickness in the SVG group (45.0?μm vs 38.5?μm; p?=?0.05) and increased burden of calcification (calcified lesion length?=?0.4?mm vs 1.8?mm; p?=?0.007; calcified quadrants?=?0.2 vs 0.9; p?=?0.001; arc of superficial calcium deposits?=?11.6° vs 50.9°; p?=?0.007) when compared to NCA.ConclusionThis OCT study has demonstrated that vein grafts have a uniquely atherogenic environment which leads to the development of calcified, lipogenic, thin-capped fibro-atheroma's, which may be pivotal in the increased, acute and chronic graft failure rate, and may underpin the increased adverse outcomes following vein graft PCI. |
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Keywords: | OCT Vein grafts ACS TCFA Calcium |
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