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Long-term angiographic and clinical outcome of patients undergoing multivessel coronary stenting
Insights
Multivessel coronary stenting is a safe and effective procedure that reduces the need for repeat interventions, including bypass surgery, while maintaining similar long-term survival rates compared to traditional angioplasty.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Multivessel coronary angioplasty shows feasibility and similar survival to bypass surgery.
- Repeat interventions, especially coronary artery bypass graft surgery, remain a challenge.
- Investigating multivessel stenting to reduce repeat interventions is crucial.
Purpose of the Study:
- To evaluate the safety and effectiveness of multivessel stenting.
- To determine if multivessel stenting reduces the need for repeat interventions, particularly bypass surgery.
Main Methods:
- 100 patients with multivessel coronary stenting between March 1993 and June 1995.
- High-pressure stent optimization used in all cases.
- Procedural success rate of 97% with 2% requiring emergency bypass surgery.
Main Results:
- Angiographic follow-up in 89% of patients showed restenosis in 22% of lesions.
- Clinical follow-up in all patients revealed 30% needed target lesion revascularization.
- Overall survival was 96%, with only 2% requiring coronary bypass surgery.
Conclusions:
- Multivessel coronary stenting offers a high success rate and low need for emergency bypass surgery.
- Compared to multivessel percutaneous transluminal coronary angioplasty, stenting reduces repeat interventions.
- Multivessel stenting demonstrates similar long-term survival rates and decreased need for bypass surgery.
Background:
Randomized clinical trials have shown that multivessel coronary angioplasty is feasible and provides similar long-term survival as bypass surgery in selected patients. However, the higher need for repeat intervention, in particular, coronary artery bypass graft surgery, remains a problem. The objective of this study was to test the hypothesis that multivessel stenting is safe and effective in reducing the need for repeat interventions, in particular, the need for bypass surgery.
Methods And Results:
Between March 1993 and June 1995, 100 consecutive patients (243 lesions) had multivessel coronary stenting. High-pressure stent optimization was used in all patients. Procedural success was achieved in 97% of lesions; 2 patients (2%) required emergency bypass surgery. Angiographic follow-up was obtained in 89% of patients at 5.2+/-2.5 months. Angiographic restenosis occurred in 22% of the lesions, but 37% of patients had > or = 1 lesion with restenosis. Clinical follow-up was obtained in all patients at 21 +/- 10 months: target lesion revascularization was needed in 30 patients (30%), repeat angioplasty in 28 patients (28%) and coronary bypass surgery in 2 patients (2%); the overall survival rate was 96% (2% noncardiac death).
Conclusions:
Multivessel coronary stenting can be performed with high success rate and low need for emergency bypass surgery. Compared with historical results with multivessel percutaneous transluminal coronary angioplasty, patients who undergo multivessel stenting need less repeat interventions, in particular, less coronary bypass surgery and have similar long-term survival.