Clinical outcome of patients undergoing endoluminal coronary artery reconstruction with three or more stents

Verghese Mathew, David Hasdai, David Holmes, Kirk N. Garratt, Malcolm R. Bell, Amir Lerman, Steven Melby, Diane E. Grill, Peter B. Berger

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)676-681
Number of pages6
JournalJournal of the American College of Cardiology
Volume30
Issue number3
DOIs
StatePublished - Jul 1997

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Stents
Coronary Vessels
Coronary Artery Bypass
Transplants
Myocardial Infarction
Angioplasty
Survivors
Dissection
Thrombosis
Incidence

ASJC Scopus subject areas

  • Nursing(all)

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Clinical outcome of patients undergoing endoluminal coronary artery reconstruction with three or more stents. / Mathew, Verghese; Hasdai, David; Holmes, David; Garratt, Kirk N.; Bell, Malcolm R.; Lerman, Amir; Melby, Steven; Grill, Diane E.; Berger, Peter B.

In: Journal of the American College of Cardiology, Vol. 30, No. 3, 07.1997, p. 676-681.

Research output: Contribution to journalArticle

Mathew, Verghese ; Hasdai, David ; Holmes, David ; Garratt, Kirk N. ; Bell, Malcolm R. ; Lerman, Amir ; Melby, Steven ; Grill, Diane E. ; Berger, Peter B. / Clinical outcome of patients undergoing endoluminal coronary artery reconstruction with three or more stents. In: Journal of the American College of Cardiology. 1997 ; Vol. 30, No. 3. pp. 676-681.
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abstract = "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.",
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AU - Mathew, Verghese

AU - Hasdai, David

AU - Holmes, David

AU - Garratt, Kirk N.

AU - Bell, Malcolm R.

AU - Lerman, Amir

AU - Melby, Steven

AU - Grill, Diane E.

AU - Berger, Peter B.

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AB - 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.

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