TY - JOUR
T1 - Major clinical events after coronary stenting
T2 - The multicenter registry of acute and elective Gianturco-Roubin stent placement
AU - Sutton, Joseph M.
AU - Ellis, Stephen G.
AU - Roubin, Gary S.
AU - Pinkerton, Cass A.
AU - King, Spencer B.
AU - Raizner, Albert E.
AU - Holmes, David R.
AU - Kereiakes, Dean J.
AU - Topol, Eric J.
PY - 1994/3
Y1 - 1994/3
N2 - Background: Abrupt vessel closure and early reocclusion remain the principal vascular events underlying early recurrent ischemia complicating elective percutaneous transluminal coronary angioplasty (PTCA). Intracoronary stenting has been used to circumvent emergency bypass surgery after acute vessel closure and as an adjunct for the elective treatment of restenosis. The initial multicenter experience with the Gianturco-Roubin stent is presented, and predictors for early recurrent ischemic events are identified. Methods and Results: Data accrued from 639 serial patients undergoing emergency stenting for abrupt closure (n=415; 65%) or elective deployment for restenosis (n=224; 35%) from October 1989 through May 1991 were analyzed. The incidence of subsequent ischemic events, including death, nonfatal myocardial infarction, and bypass surgery referral within 90 days of the procedure, was higher after acute deployment (20%) compared with elective stenting (9%; P=.0004). Although mortality within the two cohorts was the same (3%; P=NS), there were significant differences in the incidence of nonfatal myocardial infarction (5% versus 0.5%; P=.002) and bypass surgery (12% versus 6%; P=.02) between the acutely and electively stented patients, respectively. These events were significantly more common when the stent was undersized to the target vessel diameter (stent:artery ratio for event, 0.95±0.14 versus no event, 1.04±0.22; P=.0001) or when there was less expansion of the lesion by the deployed device (stent-to-lesion diameter ratio for event, 6.6±9.2 versus no event, 11.0±21.4; P=.0001). In a stepwise logistic regression model, acute stenting (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.3 to 2.4), multivessel disease (OR, 1.4; CI, 1.1 to 1.8), larger target lesion diameter (OR, 2.1; CI, 1.4 to 3.2), larger target vessel (OR, 2.9; CI, 1.7 to 4.7), and smaller stent size (OR, 6.1; CI, 3.0 to 12.3) were independent predictors of early, recurrent ischemic events. The presence of thrombus was associated with a higher event rate after elective stenting (OR, 2.3; CI, 1.06 to 5.4) but was not associated with a higher early event rate after acute stenting. Conclusions: Early ischemic events are more common after acute stenting for abrupt or threatened closure than after elective deployment. These events may be avoided with careful attention to morphometric characteristics to avoid undersizing the stent to the target vessel and ensure adequate lesion expansion.
AB - Background: Abrupt vessel closure and early reocclusion remain the principal vascular events underlying early recurrent ischemia complicating elective percutaneous transluminal coronary angioplasty (PTCA). Intracoronary stenting has been used to circumvent emergency bypass surgery after acute vessel closure and as an adjunct for the elective treatment of restenosis. The initial multicenter experience with the Gianturco-Roubin stent is presented, and predictors for early recurrent ischemic events are identified. Methods and Results: Data accrued from 639 serial patients undergoing emergency stenting for abrupt closure (n=415; 65%) or elective deployment for restenosis (n=224; 35%) from October 1989 through May 1991 were analyzed. The incidence of subsequent ischemic events, including death, nonfatal myocardial infarction, and bypass surgery referral within 90 days of the procedure, was higher after acute deployment (20%) compared with elective stenting (9%; P=.0004). Although mortality within the two cohorts was the same (3%; P=NS), there were significant differences in the incidence of nonfatal myocardial infarction (5% versus 0.5%; P=.002) and bypass surgery (12% versus 6%; P=.02) between the acutely and electively stented patients, respectively. These events were significantly more common when the stent was undersized to the target vessel diameter (stent:artery ratio for event, 0.95±0.14 versus no event, 1.04±0.22; P=.0001) or when there was less expansion of the lesion by the deployed device (stent-to-lesion diameter ratio for event, 6.6±9.2 versus no event, 11.0±21.4; P=.0001). In a stepwise logistic regression model, acute stenting (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.3 to 2.4), multivessel disease (OR, 1.4; CI, 1.1 to 1.8), larger target lesion diameter (OR, 2.1; CI, 1.4 to 3.2), larger target vessel (OR, 2.9; CI, 1.7 to 4.7), and smaller stent size (OR, 6.1; CI, 3.0 to 12.3) were independent predictors of early, recurrent ischemic events. The presence of thrombus was associated with a higher event rate after elective stenting (OR, 2.3; CI, 1.06 to 5.4) but was not associated with a higher early event rate after acute stenting. Conclusions: Early ischemic events are more common after acute stenting for abrupt or threatened closure than after elective deployment. These events may be avoided with careful attention to morphometric characteristics to avoid undersizing the stent to the target vessel and ensure adequate lesion expansion.
KW - stenosis
KW - stents
KW - thrombosis
UR - http://www.scopus.com/inward/record.url?scp=0028230123&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0028230123&partnerID=8YFLogxK
U2 - 10.1161/01.CIR.89.3.1126
DO - 10.1161/01.CIR.89.3.1126
M3 - Article
C2 - 8124799
AN - SCOPUS:0028230123
SN - 0009-7322
VL - 89
SP - 1126
EP - 1137
JO - Circulation
JF - Circulation
IS - 3
ER -