Long-term angiographic and clinical outcome after implantation of a ballon-expandable stent in the native coronary circulation

Michael P. Savage, David L. Fischman, Richard A. Schatz, Paul S. Teirstein, Martin B. Leon, Donald Baim, Stephen G. Ellis, Eric J. Topol, John W. Hirshfeld, Michael W. Cleman, Maurice Buchbinder, Steven Bailey, Richard Heuser, Craig M. Walker, R. Charles Curry, Sharon Gebhardt, Randal Rake, Sheldon Goldberg

Research output: Contribution to journalArticlepeer-review

172 Scopus citations

Abstract

Objectives. The purpose of this study was to examine the long-term clinical and angiographic outcome after coronary implantation. Background. Previous reports haw shown a discordance between the excellent initial angiographic results and subsequent adverse clinical events after coronary artery stenting. Methods. Single Palmaz-Schatz stents were electively implanted in the native coronary arteries of 300 consecutive patients. Angiograms were obtained at baseline, after balloon angioplasty, after stent implantation and at 6 months after implantation. Films were analyzed by a panel of engiographers utilizing en automated edge detection program, Clinical events, including death, myocardial infarction, coronary bypass surgery and repeat angioplasty, were recorded for 1 year. Results. Although there were no acute in-laboratory vessel closures, stent thrombosis occurred in 14 patients (4.7%) at a mean ±SD of 5 ± 3 days after implantation. Two hundred fifty-eight (90%) of 286 eligible patients had follow-up angiography at 6.1 ± 2.2 months after stent implantation. Minimal lumen diameter increased from 0.80 ± 039 mm at baseline to 1.65 +- 0.51 mm after angioplasty and further increased to 2.55 ± 0.49 mm after stent placement (p = 0.0001). At follow-up there was a 0.85-mm late loss in lumen diameter, with a final minimal lumen diameter at 6 months of 1.70 ± 0.71 mm. Restenosis, defined as ≥ 50% diameter stenosis at follow-up, occurred in 14% of patients with previously untreated lesions and in 39% of patients with previous angioplasty (p < 0.001). Clinical events after 1 year for the entire group of 300 patients included death in 0.7%, myocardial infarction in 3.7%, bypass grafting in 8% and repeat angioplasty in 13%. Freedom from any adverse clinical event was 80% for all treated patients and 87% for those with previously untreated lesions. Conclusions. Elective use of this balloon-expandable stent in the native coronary circulation is associated with a low restenosis rate by quantitative angiography in previously untreated lesions and a favorable clinical outcome with an excellent event-free survival rate at 1 year.

Original languageEnglish (US)
Pages (from-to)1207-1212
Number of pages6
JournalJournal of the American College of Cardiology
Volume24
Issue number5
DOIs
StatePublished - Nov 1 1994

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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