Native vessel vs SVG PCI: Which procedure is more effective?

Percutaneous coronary intervention (PCI) of the saphenous vein graft (SVG) results in improvements in 1-year clinical outcomes relative to native vessel PCI, reports a study. 

This is primarily driven by the “lower rates of PCI-related myocardial infarction (MI) and clinically driven target coronary territory revascularization,” according to the authors.

Two hundred twenty patients (mean age 73 years, 84 percent men) were randomized to either native vessel PCI (n=108) or SVG PCI (n=112) between January 2019 and December 2023. Major adverse cardiac events at 1 year occurred in significantly more patients in the native vessel vs SVG PCI group (34 percent vs 19 percent; hazard ratio [HR], 2.14, 95 percent confidence interval [CI], 1.25‒3.65; p=0.006).

No significant between-group differences were noted for all-cause mortality (HR, 1.59, 95 percent CI, 0.45‒5.64; p=0.472). However, nonfatal target coronary territory MI (HR, 2.12, 95 percent CI, 1.08‒4.17; p=0.029) and clinically driven target coronary territory revascularization (HR, 2.19, 95 percent CI, 1.02‒4.72; p=0.044) occurred more frequently in the native vessel PCI group.

Furthermore, the incidence of PCI-related MI was greater in the native vessel than the SVG PCI arm (13 percent vs 1 percent; HR, 14.85, 95 percent CI, 1.95‒112.96; p=0.009).

This trial was conducted across 14 centres in Europe and included patients with significant SVG stenosis and a heart team‒defined clinical indication for revascularization. 

The authors assessed the occurrence of major adverse cardiac events at 1 year following the index PCI, defined as the composite of all-cause mortality, nonfatal target coronary territory MI, or clinically driven target coronary territory revascularization, analysed on an intent-to-treat basis. Long-term follow-up is ongoing.