Circulation, Vol 89, 1126-1137, Copyright © 1994 by American Heart Association
JM Sutton, SG Ellis, GS Roubin, CA Pinkerton, SB King 3rd, AE Raizner, DR Holmes, DJ Kereiakes and EJ Topol
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.
ARTICLES
Major clinical events after coronary stenting. The multicenter registry of acute and elective Gianturco-Roubin stent placement. The Gianturco- Roubin Intracoronary Stent Investigator Group
Department of Cardiology, Cleveland Clinic Foundation, OH 44195-5001.
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