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Baseline clinical and angiographic variables associated with long-term outcome after successful intracoronary stent
V Mathew1, D E Grill, C G Scott
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA. mathew.verghese@mayo.edu
Insights
Predicting long-term outcomes after coronary stent implantation is crucial for high-risk patients. This study identified key clinical and procedural factors, such as congestive heart failure and prior myocardial infarction, that significantly influence patient results after stenting.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Outcomes Research
Background:
- Randomized trials show stent benefits over balloon angioplasty in simple coronary narrowings for low-risk patients.
- Stent efficacy is less clear for complex lesions and high-risk patient populations.
- Identifying predictors of long-term outcomes is essential for optimizing stent therapy.
Purpose of the Study:
- To identify clinical and angiographic variables associated with long-term outcomes after successful coronary stent implantation.
- To stratify risk in patients undergoing stent procedures.
- To inform clinical decision-making for complex coronary interventions.
Main Methods:
- Analysis of 1,709 patients with successful stent placement and no in-hospital major adverse events.
- Evaluation of clinical, lesional, and procedural variables using Cox proportional-hazards models.
- Long-term follow-up averaging 1.6 years to assess outcomes.
Main Results:
- History of congestive heart failure, recent myocardial infarction (MI) procedure, vein graft intervention, and prior MI were associated with increased death/MI.
- Multivessel stent placement and stenting for abrupt closure increased repeat revascularization.
- Congestive heart failure, multivessel stenting, warfarin therapy, and recent MI procedure increased the composite endpoint of death/MI/repeat revascularization.
Conclusions:
- Readily identifiable patient and procedural characteristics predict long-term outcomes after coronary stent implantation.
- Factors like congestive heart failure and prior MI are significant risk factors for adverse events.
- Optimizing stent selection and procedural strategy based on these predictors may improve patient outcomes.
Abstract:
Although randomized studies have demonstrated improved outcomes with stents over balloon angioplasty in straightforward coronary narrowings in low-risk patients, this advantage is less clear for complex lesions and high-risk patients. This study was designed to identify clinical and angiographic variables that are associated with long-term outcome after stent implantation. We identified 1,709 patients undergoing successful stent placement without in-hospital major adverse events. We analyzed clinical, lesional, and procedural variables to determine their correlation with outcome. Mean duration of follow-up was 1.6 +/- 1.4 years. Cox proportional-hazards models and stepwise methods were used to assess which covariates were potentially related to each end point. The occurrence of death/myocardial infarction (MI) was associated with any history of congestive heart failure (relative risk [RR] 3.3, 95% confidence interval [CI] 2.3 to 4.7, p <0.0001), procedure within 24 hours of MI (RR 2.3, CI 1.3 to 4.1, p = 0.0048), vein graft intervention (RR 1.8, CI 1.3 to 2.6, p = 0.0007), and prior MI (RR 1.8, CI 1.2 to 2.6, p = 0.004). Repeat revascularization was associated with multivessel stent placement (RR 1.8, CI 1.2 to 2.8, p = 0.006) and stent for abrupt closure (RR 1.7, CF 1.1 to 2.7, p = 0.03), but was less frequent with de novo lesions and right coronary artery lesions (RR 0.6, CI 0.5 to 0.8, p = 0.0007, and RR 0.8, CI 0.6 to 1.0, p = 0.05, respectively). The cumulative end point of death/MI/repeat revascularization was associated with congestive heart failure (RR 1.7, CI 1.3 to 2.2, p <0.0001), multivessel stent placement (RR 1.6, Cl 1.1 to 2.3, p = 0.03), warfarin therapy (RR 1.4, CI 1.2 to 1.8, p = 0.001), and procedure within 24 hours of MI (RR 1.5, CI 1.1 to 2.1, p = 0.02), but was less frequent with complete revascularization and right coronary artery intervention (RR 0.8, CI 0.7 to 0.99, p = 0.04, and RR 0.7, CI 0.6 to 0.9, p = 0.009, respectively). Thus, this study demonstrates that there are readily identifiable characteristics in patients treated successfully with stents that are associated with long-term outcome.