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Predictors of long-term clinical outcome in patients undergoing multiple vessel stenting for coronary artery disease
I Sheiban1, F Leonardo, G M Rosano
1Department of Internal Medicine, University of Turin, Italy. isheiban@yahoo.com
Insights
Multiple stenting for multivessel coronary artery disease offers acceptable outcomes. Female gender and diabetes are predictors of adverse events, necessitating personalized treatment strategies for coronary artery stenting.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Coronary artery stenting is superior to angioplasty alone in reducing restenosis.
- Increasing use of stenting in multivessel coronary artery disease leads to more multiple stent procedures.
- Clinical outcomes and predictors for patients receiving multiple stents are not well-established.
Purpose of the Study:
- To evaluate the clinical outcomes of patients with multivessel coronary artery disease undergoing multiple stenting.
- To identify predictors of adverse events in patients receiving multiple coronary stents.
Main Methods:
- A study of 133 consecutive patients receiving more than one stent in at least two coronary vessels.
- Implantation of 375 coronary stents (average 2.8 per patient) in elective procedures.
- Complete clinical follow-up was achieved for all patients.
Main Results:
- Low rates of mortality (1.5%) and myocardial infarction (3%) were observed.
- 72.1% of patients remained angina-free, while 23.3% experienced angina recurrence.
- Female gender and diabetes were significant predictors for repeat revascularization and adverse cardiac events.
Conclusions:
- Multiple vessel stenting is a viable therapeutic option for multivessel coronary artery disease.
- The procedure demonstrates acceptable immediate and long-term clinical outcomes.
- Female gender and diabetes mellitus are key predictors of adverse long-term outcomes.
Background:
Coronary artery stenting reduces the restenosis rate compared to coronary angioplasty alone. With the increased number of procedures completed with stent placement there has been a parallel increase in the number of procedures performed in patients with multivessel disease and therefore a rise in the number of patients receiving multiple stents. The clinical outcome and the predictors of the outcome of patients receiving multiple stents are not known.
Methods:
To evaluate the clinical outcome of patients with multivessel coronary artery disease undergoing multiple stenting we studied 133 consecutive patients who had received > 1 stent in at least two vessels. A total of 375 coronary stents (2.8 stent per patient) were implanted in elective procedure situations. Clinical follow-up was complete in 100%.
Results:
During follow-up 2 patients (1.5%) died (1 cardiac death), 4 patients (3%) had acute myocardial infarction, 96 patients (72.1%) remained angina-free, and 31 patients (23.3 %) had recurrence of angina. Repeat revascularization procedure was performed in 45 patients (33.8%); 43 patients (32.3%) underwent coronary angioplasty; 2 patients (1.5%) underwent coronary artery bypass grafting. The female gender and the presence of diabetes were significant (p < 0.05) predictors for coronary angioplasty or coronary artery bypass grafting procedures during follow-up. Recurrence of angina was also significantly (p < 0.05) associated with unstable angina at the time of the first procedure as well as diabetes and the female gender. Diabetes, the female gender and unstable angina were highly predictive factors of major adverse cardiac events during follow-up.
Conclusions:
Multiple vessel stenting in patients with multivessel coronary artery disease is associated with an acceptable immediate and long-term clinical outcome and could be considered as an alternative therapeutic option in these patients. Predictors of an adverse long-term outcome are the female gender and the presence of diabetes mellitus.