Major clinical events after coronary stenting: The multicenter registry of acute and elective Gianturco-Roubin stent placement

Joseph M. Sutton, Stephen G. Ellis, Gary S. Roubin, Cass A. Pinkerton, Spencer B. King, Albert E. Raizner, David Holmes, Dean J. Kereiakes, Eric J. Topol

Research output: Contribution to journalArticle

118 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1126-1137
Number of pages12
JournalCirculation
Volume89
Issue number3
DOIs
StatePublished - Jan 1 1994
Externally publishedYes

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Stents
Registries
Odds Ratio
Confidence Intervals
montirelin
Emergencies
Logistic Models
Myocardial Infarction
Coronary Balloon Angioplasty
Incidence
Blood Vessels
Thrombosis
Referral and Consultation
Ischemia
Arteries
Equipment and Supplies
Mortality

Keywords

  • stenosis
  • stents
  • thrombosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Sutton, J. M., Ellis, S. G., Roubin, G. S., Pinkerton, C. A., King, S. B., Raizner, A. E., ... Topol, E. J. (1994). Major clinical events after coronary stenting: The multicenter registry of acute and elective Gianturco-Roubin stent placement. Circulation, 89(3), 1126-1137. https://doi.org/10.1161/01.CIR.89.3.1126

Major clinical events after coronary stenting : The multicenter registry of acute and elective Gianturco-Roubin stent placement. / Sutton, Joseph M.; Ellis, Stephen G.; Roubin, Gary S.; Pinkerton, Cass A.; King, Spencer B.; Raizner, Albert E.; Holmes, David; Kereiakes, Dean J.; Topol, Eric J.

In: Circulation, Vol. 89, No. 3, 01.01.1994, p. 1126-1137.

Research output: Contribution to journalArticle

Sutton, JM, Ellis, SG, Roubin, GS, Pinkerton, CA, King, SB, Raizner, AE, Holmes, D, Kereiakes, DJ & Topol, EJ 1994, 'Major clinical events after coronary stenting: The multicenter registry of acute and elective Gianturco-Roubin stent placement', Circulation, vol. 89, no. 3, pp. 1126-1137. https://doi.org/10.1161/01.CIR.89.3.1126
Sutton, Joseph M. ; Ellis, Stephen G. ; Roubin, Gary S. ; Pinkerton, Cass A. ; King, Spencer B. ; Raizner, Albert E. ; Holmes, David ; Kereiakes, Dean J. ; Topol, Eric J. / Major clinical events after coronary stenting : The multicenter registry of acute and elective Gianturco-Roubin stent placement. In: Circulation. 1994 ; Vol. 89, No. 3. pp. 1126-1137.
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abstract = "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.",
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author = "Sutton, {Joseph M.} and Ellis, {Stephen G.} and Roubin, {Gary S.} and Pinkerton, {Cass A.} and King, {Spencer B.} and Raizner, {Albert E.} and David Holmes and Kereiakes, {Dean J.} and Topol, {Eric J.}",
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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

AU - Kereiakes, Dean J.

AU - Topol, Eric J.

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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.

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