Clinical outcome after multivessel coronary stent implantation
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V Mathew1, K N Garratt, D R Holmes
1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA. mathew.verghese@mayo.edu
Insights
Multivessel coronary stent placement offers excellent success rates for complex coronary artery disease, significantly reducing the need for repeat procedures compared to balloon angioplasty alone. This advanced intervention improves patient outcomes and long-term freedom from revascularization.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) for multivessel coronary artery disease has limitations including higher complication rates and repeat revascularization needs.
- Intracoronary stent placement has demonstrated a reduction in acute complications and subsequent revascularization compared to PTCA alone.
- This study evaluates outcomes in patients undergoing successful multivessel coronary intervention with stents.
Purpose of the Study:
- To assess the outcomes of patients who underwent successful multivessel coronary intervention using stents.
- To compare the efficacy of multivessel stenting against historical controls of multivessel PTCA.
Main Methods:
- Analysis of 175 patients without coronary artery bypass grafts who underwent multivessel coronary revascularization with attempted stent placement in all treated segments (January 1992-March 1998).
- Evaluation of clinical and angiographic characteristics and patient outcomes.
- Kaplan-Meier survival analysis for freedom from death, myocardial infarction, and revascularization.
Main Results:
- Successful stent placement was achieved in 428 lesions (100% angiographic success), including 74.5% of complex type B2 and C lesions.
- Procedural success was high at 98.3% (172 patients), with a low in-hospital mortality of 1.7% and no Q-wave myocardial infarction or need for coronary artery bypass grafting.
- At 12 months, the probability of freedom from death or myocardial infarction was 96.6%, from any revascularization was 81.7%, and combined events was 79.8%.
Conclusions:
- Multivessel coronary stent placement is a safe and effective procedure with excellent success rates, even in patients with complex coronary lesions.
- Stenting significantly improves event-free survival and reduces the need for repeat revascularization compared to historical multivessel PTCA.
- The use of long-acting nitrates was significantly reduced at 12-month follow-up, indicating improved patient status.
Background:
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.
Methods:
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.
Results:
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).
Conclusions:
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.
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