Mid-term Angioscopic Assessment of Saphenous Vein Grafts after Coronary Bypass

Background: We made a long-term assessment of saphenous vein graft (SVG) neo-intima after coronary bypass (CABG) using intracoronary angioscopy. Methods: Seventy-eight SVGs from 78 patients were assessed after CABG. The patients were divided into two groups: group I consisted of 34 patients whose SVG had yellow plaque of more than grade II; group II consisted of 44 patients whose SVG neo-intima was clear white. Follow-up duration, serum lipid level, type of statin and anti-thrombus drugs, among other factors, were compared between the groups. Results: Age, sex, prevalence of coronary risk factors, and follow-up duration were similar. The serum LDL level (I: 122.3±56.3 vs II: 85.8±26.1 mg/dl) and LDL/HDL ratio (I: 2.93±1.37 vs II: 1.68±0.69) were significantly higher in group I than in group II, whereas the serum HDL level (I: 43.4±11.5 vs II: 54.1±15.3 mg/dl) was significantly lower in group I (P=0.0003) than in group II. More than 85% of patients in both groups received statin therapy, but 88.2% of group I patients were administered a mild statin, whereas 95.5% of group II patients were administered a strong statin. All patients were under aspirin therapy, but additional ticlopidine was prescribed to significantly more patients in group II (I: 14.7% vs II: 70.5%, P<0.0001). On the other hand, additional warfarin therapy was administered significantly more in group I (I: 29.4% vs II: 0.4%, P=0.0351). The incidence of floating white thrombi was significantly higher in group I (I: 27 SVGs, 81.8% vs II: 4 SVGs, 10%, P<0.0001). Conclusion: Intensive lipid-lowering therapy with strong statins could be quite an attractive method of avoiding post-CABG SVG disease. Ticlopidine in addition to aspirin therapy inhibited SVG thrombi, but warfarin had no effect.