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Multivessel coronary stenting: predictors of early and late outcome
C Briguori1, T Nishida, M Adamian
1Centro Cuore Columbus, Milan, Italy.
Insights
Multivessel coronary stenting, including the left anterior descending artery, is safe with low adverse events. Patient-specific factors like jeopardy score and diabetes mellitus influence outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Limited data exists on early and late outcomes of multivessel coronary stenting.
- Previous studies often excluded the left anterior descending (LAD) artery, potentially not representing typical surgical candidates.
- This study addresses the outcomes in patients undergoing multivessel stenting that includes the LAD artery.
Purpose of the Study:
- To evaluate the safety and efficacy of multivessel coronary stenting, specifically when the LAD artery is included.
- To identify predictors of acute and long-term major adverse coronary events (MACE) following this procedure.
- To assess the risk-benefit ratio in a broader patient population.
Main Methods:
- A consecutive series of 272 patients undergoing multivessel stent implantation, including the LAD artery, were analyzed.
- In-hospital and long-term (18 +/- 4 months) clinical outcomes were prospectively evaluated.
- Clinical, angiographic, and procedural variables were assessed to determine predictors of MACE.
Main Results:
- In-hospital MACE occurred in 6.6% of patients (death 0.7%, CABG 0.4%, MI 6.3%).
- Acute and subacute stent thrombosis rates were 1.5% and 1.1%, respectively.
- At 18 months, event-free survival was 71%, with 20% requiring target lesion revascularization. Jeopardy score predicted in-hospital MACE, while diabetes mellitus predicted long-term MACE.
Conclusions:
- Multivessel coronary stenting including the LAD artery is a safe procedure with acceptable acute and long-term outcomes.
- The jeopardy score and diabetes mellitus are significant predictors of adverse events and should guide treatment decisions.
- Careful risk-benefit assessment is crucial for individual patients undergoing this intervention.
Background:
At present, only few data are available on the early and late outcome following multivessel coronary stenting. Of note, in these studies, the left anterior descending (LAD) artery was treated in less than 40% of cases. These patients may not fully represent the population commonly referred for surgical revascularization.
Methods:
In-hospital and long-term (18 +/- 4 months) events were evaluated in 272 consecutive patients who had multivessel stent implantation including the LAD artery in each case. All clinical, angiographic, and procedural variables were analyzed to identify the predictors of acute and long-term major adverse coronary events.
Results:
Eighteen patients (6.6%) had in-hospital major adverse coronary events (death 0.7%, coronary artery bypass grafting 0.4%, and myocardial infarction 6.3%). Acute and subacute stent thrombosis rates were 1.5 and 1.1%, respectively. At 18 +/- 4 months, event-free survival was 71%. Target lesion revascularization was performed in 54 (20%) patients (42 coronary angioplasty and 12 coronary artery bypass grafting). The jeopardy score was the predictor of in-hospital major adverse coronary events (p = 0.016, odds ratio 1.34, 95% confidence interval 1.05-1.69), and diabetes mellitus was the predictor of long-term major adverse coronary events (p = 0.027, odds ratio 2.80, 95 % confidence interval 1.12-6.96).
Conclusions:
Multivessel coronary stent implantation with treatment of the LAD artery in all instances is a safe procedure with low acute and long-term major adverse coronary events. The risk-benefit ratio must be assessed carefully for each patient, particularly taking into account the jeopardy score and the presence of diabetes mellitus.