Clinical outcome after multivessel coronary stent implantation

Percutaneous transluminal coronary angioplasty (PTCA) has been shown to be an effective therapy for multivessel coronary artery disease, although more frequent acute complications and an increased need to repeat revascularization than with single-vessel PTCA continue to be limitations. Intracoronary stent placement has been shown to reduce the rate of acute complications and the need for subsequent revascularization. We sought to evaluate the outcome among patients undergoing successful multivessel coronary intervention with stents.

The participants were 175 patients without coronary artery bypass grafts who underwent multivessel coronary revascularization in which stent placement was attempted in all treated segments from January 1992 through March 1998 at our institution. Clinical and angiographic characteristics and outcomes were analyzed.

Stent placement was attempted for 428 coronary lesions. The angiographic success rate was 100%. Modified American College of Cardiology-American Heart Association type B2 and C lesions accounted for 74.5% of the lesions. Three patients (1.7%) died in the hospital. No patient had Q-wave myocardial infarction or needed coronary artery bypass grafting. Procedural success was achieved for 172 patients (98.3%). The Kaplan-Meier probability of freedom from death or myocardial infarction at 12 months was 96.6%, of any revascularization was 81. 7%, and of death, myocardial infarction, and any revascularization combined was 79.8%. The use of long-acting nitrates at 12 months was reduced (34.3% versus 19.1%, P =.01).

Multivessel coronary stent placement is associated with an excellent procedural success rate despite a high rate of adverse lesion characteristics and a high event-free survival rate during the follow-up period. The likelihood that revascularization will not have to be repeated during the first follow-up year is significantly better than that for historic controls of multivessel PTCA.