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Comparison of long-term (seven year) outcomes among patients undergoing percutaneous coronary revascularization with
David E Kandzari1, Robert H Tuttle, James P Zidar
1Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA. david.kandzari@duke.edu
Insights
Coronary stents significantly reduce the need for repeat procedures after percutaneous coronary intervention. However, this study found no significant difference in long-term survival rates between patients receiving stents and those treated with angioplasty alone.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Coronary stents improve short-term outcomes of percutaneous coronary intervention (PCI).
- Long-term benefits of coronary stenting compared to angioplasty alone remain uncertain.
- Key outcomes include death, myocardial infarction, and repeat target vessel revascularization (TVR).
Purpose of the Study:
- To examine long-term clinical outcomes of coronary stenting versus percutaneous transluminal coronary angioplasty (PTCA) alone.
- To compare repeat TVR, death, and myocardial infarction rates between the two treatment groups.
- To evaluate the long-term survival impact of coronary stenting.
Main Methods:
- Retrospective analysis of 6,956 patients from the Duke Cardiovascular Disease Database (1990-2002).
- Propensity modeling used to match 1,288 patients based on clinical, angiographic, and demographic factors.
- Median follow-up duration of 7 years.
Main Results:
- Coronary stenting significantly decreased repeat TVR (18.0% vs 28.1%, p=0.0002) and the composite of death, myocardial infarction, or TVR (39.2% vs 45.8%, p=0.004).
- Long-term survival rates did not significantly differ between stenting and angioplasty groups (19.9% vs 20.5%, p=0.72).
- Outcomes of death and myocardial infarction were similar regardless of repeat TVR status.
Conclusions:
- Coronary stenting provides a significant, sustained reduction in repeat revascularization compared to angioplasty alone.
- Coronary stenting does not appear to influence long-term survival.
- The findings highlight the efficacy of stents in reducing procedural re-intervention but not overall mortality.
Abstract:
Coronary stents have markedly improved the short- and intermediate-term safety and efficacy of percutaneous coronary intervention by improving acute gains in luminal dimensions, decreasing abrupt vessel occlusion, and decreasing restenosis, yet the long-term benefit of coronary stenting remains uncertain. We examined long-term clinical outcomes of death, myocardial infarction, and repeat target vessel revascularization (TVR) among patients enrolled in the Duke Database for Cardiovascular Disease who underwent revascularization with percutaneous transluminal coronary angioplasty alone or stent placement from 1990 to 2002. Among 6,956 patients who underwent percutaneous revascularization, propensity modeling was applied to identify 1,288 matched patients with a similar likelihood to receive coronary stents according to clinical, angiographic, and demographic characteristics. Significant (p <0.05) predictors of stent placement included multivessel disease, diabetes, hypertension, recent myocardial infarction, decreased ejection fraction, and year of study entry. At a median follow-up of 7 years, although treatment with coronary stenting was associated with a significant and sustained decrease in repeat TVR (18.0% vs 28.1%, p = 0.0002) and the occurrence of death, myocardial infarction or TVR (39.2% vs 45.8%, p = 0.004), long-term survival did not significantly differ between treatment groups (19.9% vs 20.5%, p = 0.72). Outcomes of death and myocardial infarction did not significantly differ between patients who did and did not undergo repeat TVR. In conclusion, compared with angioplasty alone, revascularization with coronary stents provides a significant early and sustained decrease in the need for repeat revascularization, but stents do not influence long-term survival.