Clinical Outcome of Patients Undergoing Endoluminal Coronary Artery Reconstruction With Three or More Stents

• Published in: Journal of the American College of Cardiology 1997-09, Vol.30 (3), p.676-681
• Main Authors: Mathew, Verghese, Hasdai, David, Holmes, David R, Garratt, Kirk N, Bell, Malcolm R, Lerman, Amir, Melby, Steven, Grill, Diane E, Berger, Peter B
• Format: Article
• Language: English
• Subjects: Angioplasty, Balloon, Coronary - mortality; Biological and medical sciences; Coronary Angiography; Coronary Artery Bypass - mortality; Coronary Disease - diagnostic imaging; Coronary Disease - mortality; Coronary Disease - therapy; Coronary Vessels - injuries; Diseases of the cardiovascular system; Female; Follow-Up Studies; Hospital Mortality; Humans; Male; Medical sciences; Middle Aged; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Recurrence; Retrospective Studies; Stents - adverse effects; Treatment Outcome
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(97)00207-6

Objectives. We sought to evaluate the outcome of patients undergoing multiple (three or more), contiguous stent implantation within a single native coronary artery. Background. The implantation of multiple stents within a single coronary artery is increasing in frequency, although the outcome of such patients is not well described. Methods. Forty-five patients without previous coronary artery bypass graft surgery (CABG) undergoing multiple, contiguous stent implantation in a single coronary artery were identified. Clinical and angiographic characteristics and outcomes were analyzed. Results. The angiographic success rate was 97.8%. The procedural success rate was 91.1%; stent occlusion during the initial hospital period occurred in four patients (8.9%). Death, myocardial infarction (MI), CABG, repeat target vessel intervention or severe angina occurred in 10 (23.3%) of 43 hospital survivors at 6-month follow-up. The indication for stent placement was threatened or abrupt closure in 30 patients (66.7%). Of the 25 patients with abrupt or threatened closure whose clinical and angiographic data would have indicated emergent CABG had stents not been available, the frequency of in-hospital death and Q wave MI was similar to that of a matched consecutive series of patients at our institution who underwent emergent CABG after failed angioplasty. At 1 year, the frequency of death, Q wave MI, CABG and severe angina at 1 year was similar in the two groups; the need for repeat percutaneous intervention was more common in the stent group (25% vs. 0%, p = 0.01). Conclusions. Implantation of multiple, contiguous intracoronary stents was associated with a high initial success rate, although the incidence of early stent closure was relatively high. Adverse events at 6 months of follow-up were more frequent than previously reported for elective single-stent implantation; however, adverse angiographic characteristics such as dissection and thrombus were frequent in this group. In addition, the strategy of multiple stent implantation in the setting of failed angioplasty is a reasonable alternative to emergent CABG, although the need for further percutaneous intervention must be anticipated.