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Intracoronary stenting and risk for major adverse cardiac events during the first month
H Schühlen1, A Kastrati, J Dirschinger
1Deutsches Herzzentrum München and 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Germany. h.schuehlen@med1.med.tu-muenchen.de
Insights
This study analyzed stenting procedure outcomes, identifying risks for failure and major adverse cardiac events (MACE). A risk stratification protocol was developed to guide post-procedure care and improve stenting quality control.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Technology Assessment
Background:
- Assessing procedural failure and major adverse cardiac events (MACE) risks in stenting is crucial.
- Developing risk stratification protocols enhances patient care and procedural outcomes.
Purpose of the Study:
- To analyze the risk of procedural failure during stenting.
- To evaluate the risk of MACE after successful stenting.
- To create a risk stratification protocol for successful stenting procedures.
Main Methods:
- Retrospective analysis of 2894 stenting procedures over 5 years.
- Identification of risk factors for procedural failure and MACE.
- Development of a risk stratification protocol based on procedural and patient variables.
Main Results:
- Stenting success rate was 98.3%. MACE rate after failure was 42.6%.
- Independent risk factors for MACE included older age, diabetes, acute myocardial infarction, unstable angina, impaired left ventricular function, residual dissections, stent overlap, and longer stented segments.
- Procedural factors were stronger predictors of MACE than pre-procedural variables. Risk declined after 3 days, with residual dissections being a dominant early risk factor.
Conclusions:
- Optimal angiographic results and immediate-onset antiplatelet regimens are vital.
- The developed risk stratification protocol can guide postprocedural care, compare study populations, and inform quality control programs for stenting.
Background:
Our rationale for this study was to analyze the risk for procedural failure of attempted stenting and the risk for major adverse cardiac events (MACE) after success and to develop a risk stratification protocol for successful procedures.
Methods And Results:
Stenting was attempted in 2894 procedures during the 5-year study period (success in 98.3% of 3815 lesions). After failure, the MACE rate was 42.6%. The risk for failure was higher for lesions in the left circumflex coronary artery or in venous bypass grafts and after an acute occlusion before stenting; it increased with stenosis length or grade and decreased with vessel size and growing institutional experience in stenting. After success, death occurred in 0.8%, death or myocardial infarction in 2.0%, and any MACE in 3.6%. Independent risk factors for MACE were older age, diabetes, acute myocardial infarction, unstable angina, impaired left ventricular function, residual dissections, stent overlap, longer stented segments, and a postprocedural regimen without ticlopidine. Procedural factors were substantially stronger predictors than operator-independent variables available before procedures. Overall, the risk declined after the first 3 days. Two major factors exhibited time-dependent variations of their influence: while residual dissections were the dominant risk factor within the first 3 days with a reduction after that, no protective effect of ticlopidine could be identified before day 3. From these results, we derived a risk stratification protocol for individual procedures.
Conclusions:
These results underscore the importance of optimal angiographic results and the need for antiplatelet regimens with immediate onset. Our risk stratification protocol may guide individual postprocedural care and allow us to compare risk profiles of different study populations and to devise quality control programs for stenting.