Clinical outcome of patients undergoing multivessel coronary stent implantation

Verghese Mathew, Charanjit Rihal, Peter B. Berger, Malcolm R. Bell, Kirk N. Garratt, David Holmes

Research output: Contribution to journalArticle

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Abstract

Objectives: To evaluate the outcome of patients undergoing multivessel coronary stent implantation. Background: Percutaneous transluminal coronary angioplasty has been shown to be an effective treatment for multivessel coronary artery disease, although the need for repeat revascularization continues to be a limitation. Intracoronary stent placement has been shown to reduce the need for subsequent revascularization. Methods: Seventy-seven patients without prior coronary artery bypass grafting (CABG) undergoing multivessel coronary revascularization in which stents were placed in all treated segments over a 5 year period at our institution were identified. Clinical and angiographic characteristics and outcomes were analyzed. Results: One hundred and eighty-eight coronary lesions were successfully treated (2.1 ± 0.3 treated vessels/patient, 2.4 ± 0.6 treated lesions/patient) using 2.8 ± 1.2 stents/patient (range 2-9) and 1.4 ± 0.8 stents/vessel (range 1-6). Procedural success rate [angiographic success without in-hospital death, Q-wave myocardial infarction (Q-wave MI) or CABG] was achieved in 76 of 77 patients (98.7%). Anatomically complete revascularization was achieved in 46 (59.7%) patients. Modified ACC/AHA Type B2 and C lesions comprised 75.5% of the 188 lesions. The left anterior descending artery was treated in 57 (74.0%) patients. The indication for stent placement was dissection or threatened/abrupt closure in 54 segments (28.8%). In-hospital events included death in one patient (1.3%); no patient suffered a Q-wave MI or required CABG. Stent occlusion occurred in two (2.6%) patients, and repeat percutaneous intervention of the target vessel was also required in these two patients. Any of these adverse events occurred in three(3.9%) patients. No further events occurred after hospital discharge in the 30 days after the procedure. Of hospital survivors (n=76), adverse events at 6 months included death in two patients (2.6%), MI in two (2.6%), CABG in six (7.9%); nine (11.8%) patients underwent repeat percutaneous intervention and 15 (19.7%) underwent any revascularization. Conclusions: Multivessel coronary stent placement is associated with an excellent procedural success rate despite a high rate of adverse lesion characteristics, and a low rate of death or MI during follow-up. The need for further revascularization compares favorably with published rates with multivessel FICA and single stent implantation for discrete de novo lesions.

Original languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalInternational Journal of Cardiology
Volume64
Issue number1
DOIs
StatePublished - Mar 13 1998

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Stents
Coronary Artery Bypass
Myocardial Infarction
Coronary Balloon Angioplasty
Survivors
Dissection
Coronary Artery Disease
Arteries

Keywords

  • Intracoronary stents
  • Multivessel coronary disease
  • Percutaneous transluminal coronary angioplasty

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Clinical outcome of patients undergoing multivessel coronary stent implantation. / Mathew, Verghese; Rihal, Charanjit; Berger, Peter B.; Bell, Malcolm R.; Garratt, Kirk N.; Holmes, David.

In: International Journal of Cardiology, Vol. 64, No. 1, 13.03.1998, p. 1-7.

Research output: Contribution to journalArticle

Mathew, Verghese ; Rihal, Charanjit ; Berger, Peter B. ; Bell, Malcolm R. ; Garratt, Kirk N. ; Holmes, David. / Clinical outcome of patients undergoing multivessel coronary stent implantation. In: International Journal of Cardiology. 1998 ; Vol. 64, No. 1. pp. 1-7.
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AU - Rihal, Charanjit

AU - Berger, Peter B.

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AU - Holmes, David

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N2 - Objectives: To evaluate the outcome of patients undergoing multivessel coronary stent implantation. Background: Percutaneous transluminal coronary angioplasty has been shown to be an effective treatment for multivessel coronary artery disease, although the need for repeat revascularization continues to be a limitation. Intracoronary stent placement has been shown to reduce the need for subsequent revascularization. Methods: Seventy-seven patients without prior coronary artery bypass grafting (CABG) undergoing multivessel coronary revascularization in which stents were placed in all treated segments over a 5 year period at our institution were identified. Clinical and angiographic characteristics and outcomes were analyzed. Results: One hundred and eighty-eight coronary lesions were successfully treated (2.1 ± 0.3 treated vessels/patient, 2.4 ± 0.6 treated lesions/patient) using 2.8 ± 1.2 stents/patient (range 2-9) and 1.4 ± 0.8 stents/vessel (range 1-6). Procedural success rate [angiographic success without in-hospital death, Q-wave myocardial infarction (Q-wave MI) or CABG] was achieved in 76 of 77 patients (98.7%). Anatomically complete revascularization was achieved in 46 (59.7%) patients. Modified ACC/AHA Type B2 and C lesions comprised 75.5% of the 188 lesions. The left anterior descending artery was treated in 57 (74.0%) patients. The indication for stent placement was dissection or threatened/abrupt closure in 54 segments (28.8%). In-hospital events included death in one patient (1.3%); no patient suffered a Q-wave MI or required CABG. Stent occlusion occurred in two (2.6%) patients, and repeat percutaneous intervention of the target vessel was also required in these two patients. Any of these adverse events occurred in three(3.9%) patients. No further events occurred after hospital discharge in the 30 days after the procedure. Of hospital survivors (n=76), adverse events at 6 months included death in two patients (2.6%), MI in two (2.6%), CABG in six (7.9%); nine (11.8%) patients underwent repeat percutaneous intervention and 15 (19.7%) underwent any revascularization. Conclusions: Multivessel coronary stent placement is associated with an excellent procedural success rate despite a high rate of adverse lesion characteristics, and a low rate of death or MI during follow-up. The need for further revascularization compares favorably with published rates with multivessel FICA and single stent implantation for discrete de novo lesions.

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KW - Multivessel coronary disease

KW - Percutaneous transluminal coronary angioplasty

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