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Results of coronary stenting for unstable versus stable angina pectoris
A Marzocchi1, G Piovaccari, C Marrozzini
1Institute of Cardiology, University of Bologna, Italy.
Insights
Coronary artery stenting is safe and effective for unstable angina patients, improving angioplasty outcomes. Combined antiplatelet therapy may reduce stent thrombosis compared to anticoagulants.
Area of Science:
- Interventional Cardiology
- Cardiovascular Medicine
Background:
- Coronary artery stenting improves outcomes in stable angina.
- Efficacy and safety in unstable angina remain uncertain.
Purpose of the Study:
- Evaluate Palmaz-Schatz stent efficacy in unstable angina patients.
- Compare outcomes between unstable and stable angina groups.
Main Methods:
- Retrospective analysis of 231 patients (132 unstable, 99 stable).
- Patients received anticoagulant or combined antiplatelet therapy post-stenting.
- Comparison of procedural success, in-hospital complications, and 6-month follow-up outcomes.
Main Results:
- High procedural success in both groups.
- Similar major in-hospital complications, mainly subacute stent thrombosis (higher with anticoagulants).
- At 6 months, lower rates of angioplasty repetition and target vessel revascularization in the unstable group.
Conclusions:
- Stent insertion enhances short- and midterm angioplasty effectiveness in unstable angina.
- Outcomes in unstable angina patients become comparable to stable angina patients.
- Combined antiplatelet therapy appears to reduce subacute stent thrombosis.
Abstract:
Coronary artery stenting has been shown to improve the short- and long-term results of coronary angioplasty in mainly stable patients with 1-vessel disease, but it is uncertain whether its use in an unstable clinical setting may be safe and useful. To evaluate the stenting efficacy in patients with unstable angina, we retrospectively examined our experience with the Palmaz-Schatz balloon expandable stent in 231 consecutive patients. Patients were divided into 2 groups on the basis of symptoms at the time of stent implantation: group U (132 patients) had unstable angina, and group S (99 patients) had stable angina. After stent insertion, patients were treated with anticoagulant or combined antiplatelet therapy. Baseline characteristics of the 2 groups were comparable with the exception of age (higher in the unstable group) and angiographic characteristics of the target lesions (more unfavorable in unstable patients). In both groups, coronary stenting presented a high procedural success rate. Major in-hospital complications occurred in 9 unstable (6.8%) and in 2 stable (2%) patients (p = NS) and were mainly related to subacute stent thrombosis. In both groups, subacute stent thrombosis mostly occurred in patients treated with anticoagulant therapy (7 of 9 unstable patients, 2 of 2 stable patients). At 6-month follow-up, unstable and stable patients had a similar incidence of death (0%), Q-wave myocardial infarction (0%), and need of coronary artery bypass graft (3.2% vs 4%, p = NS), but coronary angioplasty repetition (4.8% vs 14%, p = 0.027) and target vessel revascularization (6.3% vs 17%, p = 0.019) rates were lower in the unstable group. In conclusion, stent insertion increases the short- and midterm coronary angioplasty effectiveness in unstable angina, making it possible to achieve outcomes quite comparable to stable angina. Compared with conventional anticoagulant regimen, combined antiplatelet therapy after placement of coronary stents seems to reduce the incidence of subacute thrombosis also in this clinical setting.