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Procedural results and late clinical outcomes following multivessel coronary stenting
R Kornowski1, R Mehran, L F Satler
1Division of Cardiology, Washington Hospital Center, DC 20010, USA.
Insights
Multivessel stenting demonstrates comparable in-hospital success and complication rates to single-vessel stenting. Long-term clinical outcomes, including death and repeat revascularization, are also similar, supporting its use in select patients.
Area of Science:
- Interventional Cardiology
- Cardiovascular Medicine
- Medical Device Technology
Background:
- Multivessel coronary artery disease poses challenges due to high restenosis and angina rates with conventional angioplasty.
- The advent of coronary stents aimed to improve angioplasty outcomes, particularly for complex multivessel interventions.
Purpose of the Study:
- To compare in-hospital and long-term clinical outcomes of percutaneous multivessel stent intervention versus single-vessel stenting.
- To assess the safety and efficacy of coronary stents in treating multivessel coronary disease.
Main Methods:
- A comparative study evaluating 398 patients undergoing multivessel stenting (two or three native arteries) against 1,941 patients undergoing single-vessel stenting.
- In-hospital and one-year follow-up data collected on procedural success, complications, death, Q-wave myocardial infarction (MI), and repeat revascularization.
Main Results:
- Procedural success rates (96% vs. 97%) and complication rates (3.8% vs. 2.9%) were similar between multivessel and single-vessel stenting.
- One-year rates of target lesion revascularization (15% vs. 16%) and repeat revascularization (20% vs. 21%) were comparable.
- No significant difference in death rates; however, Q-wave MI was lower in the multivessel group (1.2% vs. 0%).
Conclusions:
- Percutaneous multivessel stenting offers similar in-hospital success and complication rates compared to single-vessel stenting.
- Long-term clinical outcomes at one year are comparable between multivessel and single-vessel stenting approaches.
- Coronary stenting represents a viable therapeutic option for carefully selected patients with multivessel coronary disease.
Objectives:
To evaluate in-hospital and long-term clinical outcomes in a large consecutive series of patients undergoing percutaneous multivessel stent intervention.
Background:
High restenosis and recurrent angina rates have limited the clinical outcomes of multivessel coronary angioplasty before stents were available to improve angioplasty results.
Methods:
We evaluated in-hospital and long-term clinical outcomes (death, Q-wave myocardial infarction [MI], and repeat revascularization rates at one year) in 398 consecutive patients treated with coronary stents in two (94% of patients) or three native arteries, compared to 1,941 patients undergoing stenting procedure in a single coronary artery between January 1, 1994 and August 29, 1997.
Results:
Overall procedural success was obtained in 96% of patients with two- or three-vessel stenting and in 970% of patients with single-vessel stent intervention (p = 0.36). Procedural complications were also similar (3.8% for multivessel versus 2.9% for single vessel, p = 0.14). During follow up, target lesion revascularization was 15% in multivessel and 16% in single-vessel interventions (p = 0.38), and repeat revascularization (calculated per treated patient) was also similar for both groups (20% vs. 21%, p = 0.73). There was no difference in death (1.4% vs. 0.7%, p = 0.26), and Q-wave MI (1.2% vs. 0%, p = 0.02) was lower following multivessel interventions. Overall cardiac event-free survival was similar for both groups (p = 0.52).
Conclusions:
Unlike previous conventional angioplasty experiences, multivessel stenting has (1) similar in-hospital procedural success and major complication rates and (2) similar long-term (one year) clinical outcomes compared with single-vessel stenting. Thus, stents may be a viable therapeutic strategy in carefully selected patients with multivessel coronary disease.