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PCI after SVG failure-native vessel or graft?
1Department of Cardiac Surgery, Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, 124, EM Bypass, Mukundapur, Kolkata, 700099 India.
Insights
Percutaneous coronary intervention (PCI) of saphenous vein grafts (SVG) showed better outcomes than native vessel PCI in a recent trial. This challenges current guidelines recommending native vessel intervention for SVG failure after bypass surgery.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Clinical Trials
Background:
- Saphenous vein graft (SVG) failure is a common complication after coronary artery bypass grafting (CABG).
- Re-intervention is often necessary, but treatment strategies remain debated.
- Current guidelines suggest prioritizing percutaneous coronary intervention (PCI) of the native coronary artery over SVG-PCI.
Purpose of the Study:
- To compare the efficacy and safety of SVG-PCI versus native coronary artery PCI in patients with prior CABG and SVG failure.
- To provide evidence to inform treatment guidelines for SVG failure.
Main Methods:
- The PROCTOR trial was a randomized controlled trial.
- It compared SVG-PCI directly with native coronary artery PCI.
- Outcomes were assessed at 1-year follow-up.
Main Results:
- SVG-PCI demonstrated significantly lower rates of major adverse cardiac events (MACE) at 1 year compared to native vessel PCI.
- This suggests SVG-PCI may be a superior re-intervention strategy in select patients.
Conclusions:
- The PROCTOR trial findings challenge existing guideline recommendations.
- SVG-PCI may be a favorable option for re-intervention in SVG failure.
- Longer-term follow-up data are needed to confirm these results.
Abstract:
Saphenous vein graft (SVG) failure following coronary artery bypass grafting may require re-intervention, with current guidelines favoring percutaneous coronary intervention (PCI) of the bypassed native coronary artery over SVG-PCI. The Percutaneous Coronary Intervention of Native Coronary Artery versus Saphenous Vein Graft in Patients with Prior Coronary Artery Bypass Graft Surgery (PROCTOR) trial is the first randomized controlled trial comparing native coronary artery PCI with SVG-PCI. The study shows that at 1 year, SVG-PCI was associated with significantly lower major adverse cardiac events than native vessel PCI. These findings question existing guideline recommendations, although longer-term follow-up is required.
