The Effect of Predilatation on Procedural Outcomes in Patients Undergoing Saphenous Vein Graft Percutaneous Coronary Intervention for Acute Coronary Syndrome

Objective: Percutaneous coronary interventions (PCI) of saphenous vein grafts (SVG) are technically challenging due to friable plaques, high thrombus burden, and the risk of distal embolization. The impact of balloon predilatation on outcomes in patients presenting with acute coronary syndrome (ACS) remains unclear. This study aimed to evaluate the effect of predilatation in patients undergoing SVG PCI.
Method: In this single-center retrospective study, 202 patients with ACS and prior coronary artery bypass graft (CABG) surgery who underwent PCI to an SVG between 2007 and 2024 were analyzed. Patients were categorized according to whether predilatation was performed before stent implantation (predilatation group, n = 112; no predilatation group, n = 90). Coronary flow was assessed using the Thrombolysis in Myocardial Infarction (TIMI) classification. Logistic regression analysis was performed to identify independent predictors of inadequate post-procedural flow (TIMI < 3).
Results: Baseline demographic and clinical characteristics were comparable between the groups. Post-procedural TIMI 3 flow was achieved in 69.6% of the predilatation group and 55.6% of the non-predilatation group (P = 0.039). Predilatation (odds ratio [OR] = 0.51, P = 0.030) and the use of glycoprotein IIb/IIIa inhibitors (OR = 0.39, P = 0.003) were independently associated with a lower risk of inadequate flow. ST-segment elevation myocardial infarction (STEMI) was associated with a higher risk of inadequate TIMI flow (OR = 2.37, P = 0.039). Lipid parameters and statin use were not associated with TIMI flow outcomes.
Conclusion: In patients with ACS undergoing SVG PCI, predilatation before stent implantation was associated with improved reperfusion, as reflected by higher rates of post-procedural TIMI 3 flow. The use of glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitors was associated with additional protection. Larger prospective studies are warranted.

Keywords: Acute coronary syndrome, percutaneous coronary intervention, predilatation, saphenous vein graft, Thrombolysis in Myocardial Infarction flow