Abstract

Objectives

To investigate the results of percutaneous coronary intervention (PCI) in saphenous vein grafts after coronary artery bypass grafting (CABG). Design. MEDLINE, Embase, and the Cochrane library were searched for relevant articles published between 1 January 2000 and 29 February 2020. The PICO (population, intervention, comparison, outcome) model was applied in constructing the clinical question. Two independent researchers performed the literature search. Thirty-six articles were identified and subjected to a quality assessment. The primary outcomes of the meta-analysis were long-term in-stent restenosis and long-term major adverse cardiac events (MACE). Results. In-stent restenosis was 9.4% (95% CI: 4.2–14.7%) and MACE was 35.3% (95% CI: 27–43.7%) at mean time 2.7 ± 1.0 years. The secondary outcomes were the unsuccessful PCI rate (7.7%; 95% CI: 2.9–12.5%), 30-day MACE (4.3%; 95% CI: 2.5–6.1%), and 1-year MACE (15.5%; 95% CI: 11.7–19.3%). The use of drug-eluting stents resulted in better outcomes at least in term of in-stent restenosis, while the benefit of using embolic protection devices was questionable. Conclusions. PCI of a stenosed or occluded saphenous vein graft is a challenge for interventional cardiologists, and is still associated with relatively high rates of restenosis, MACE, and procedural failure. All efforts to enhance the results are warranted, including improved quality of the venous grafts used during CABG.

中文翻译：

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冠状动脉旁路移植术后大隐静脉移植的经皮冠状动脉介入治疗：系统评价和荟萃分析

摘要

目标

探讨冠状动脉旁路移植术（CABG）后经皮冠状动脉介入治疗（PCI）对大隐静脉移植的效果。设计。在 MEDLINE、Embase 和 Cochrane 图书馆中搜索了 2000 年 1 月 1 日至 2020 年 2 月 29 日期间发表的相关文章。 PICO（人口、干预、比较、结果）模型用于构建临床问题。两名独立研究人员进行了文献检索。确定了 36 篇文章并对其进行了质量评估。荟萃分析的主要结果是长期支架内再狭窄和长期主要不良心脏事件 (MACE)。结果。支架内再狭窄为 9.4%（95% CI：4.2-14.7%），MACE 为 35.3%（95% CI：27-43.7%），平均时间为 2.7 ± 1.0 年。次要结果是 PCI 失败率（7.7%；95% CI：2.9–12.5%）、30 天 MACE（4.3%；95% CI：2.5–6.1%）和 1 年 MACE（15.5%；95 % CI：11.7–19.3%）。至少在支架内再狭窄方面，药物洗脱支架的使用产生了更好的结果，而使用栓塞保护装置的益处值得怀疑。结论。对狭窄或闭塞的大隐静脉移植物进行 PCI 对介入心脏病学家来说是一个挑战，并且仍然与相对较高的再狭窄、MACE 和手术失败率相关。所有提高结果的努力都是有保证的，包括提高 CABG 期间使用的静脉移植物的质量。