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Clinical outcome of patients undergoing multivessel coronary stent implantation
V Mathew1, C S Rihal, P B Berger
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA.
Insights
Multivessel coronary stent implantation shows high procedural success and low death or myocardial infarction rates. This treatment favorably compares to other revascularization methods for complex coronary artery disease.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Multivessel coronary artery disease requires effective treatment.
- Percutaneous transluminal coronary angioplasty (PTCA) is effective but has limitations.
- Intracoronary stent placement reduces repeat revascularization needs.
Purpose of the Study:
- To evaluate the outcomes of patients undergoing multivessel coronary stent implantation.
- To assess the safety and efficacy of this procedure in a real-world setting.
Main Methods:
- Retrospective analysis of 77 patients without prior coronary artery bypass grafting (CABG).
- Patients underwent multivessel coronary revascularization with stent placement in all treated segments.
- Clinical and angiographic characteristics and outcomes were analyzed over a 5-year period.
Main Results:
- High procedural success rate (98.7%) with low in-hospital adverse events (3.9%).
- Successful treatment of 188 lesions with an average of 2.4 lesions and 2.8 stents per patient.
- At 6 months, 19.7% of patients required revascularization, comparing favorably to published PTCA rates.
Conclusions:
- Multivessel coronary stent placement offers excellent procedural success.
- The procedure is safe and effective even with complex lesion characteristics.
- Outcomes compare favorably to existing treatments for multivessel coronary artery disease.
Objectives:
To evaluate the outcome of patients undergoing multivessel coronary stent implantation.
Background:
Percutaneous transluminal coronary angioplasty has been shown to be an effective treatment for multivessel coronary artery disease, although the need for repeat revascularization continues to be a limitation. Intracoronary stent placement has been shown to reduce the need for subsequent revascularization.
Methods:
Seventy-seven patients without prior coronary artery bypass grafting (CABG) undergoing multivessel coronary revascularization in which stents were placed in all treated segments over a 5 year period at our institution were identified. Clinical and angiographic characteristics and outcomes were analyzed.
Results:
One hundred and eighty-eight coronary lesions were successfully treated (2.1+/-0.3 treated vessels/patient, 2.4+/-0.6 treated lesions/patient) using 2.8+/-1.2 stents/patient (range 2-9) and 1.4+/-0.8 stents/vessel (range 1-6). Procedural success rate [angiographic success without in-hospital death, Q-wave myocardial infarction (Q-wave MI) or CABG] was achieved in 76 of 77 patients (98.7%). Anatomically complete revascularization was achieved in 46 (59.7%) patients. Modified ACC/AHA Type B2 and C lesions comprised 75.5% of the 188 lesions. The left anterior descending artery was treated in 57 (74.0%) patients. The indication for stent placement was dissection or threatened/abrupt closure in 54 segments (28.8%). In-hospital events included death in one patient (1.3%); no patient suffered a Q-wave MI or required CABG. Stent occlusion occurred in two (2.6%) patients, and repeat percutaneous intervention of the target vessel was also required in these two patients. Any of these adverse events occurred in three (3.9%) patients. No further events occurred after hospital discharge in the 30 days after the procedure. Of hospital survivors (n=76), adverse events at 6 months included death in two patients (2.6%), MI in two (2.6%), CABG in six (7.9%); nine (11.8%) patients underwent repeat percutaneous intervention and 15 (19.7%) underwent any revascularization.
Conclusions:
Multivessel coronary stent placement is associated with an excellent procedural success rate despite a high rate of adverse lesion characteristics, and a low rate of death or MI during follow-up. The need for further revascularization compares favorably with published rates with multivessel PTCA and single stent implantation for discrete de novo lesions.