Author + information
- Received October 17, 1991
- Revision received January 2, 1992
- Accepted January 18, 1992
- Published online August 1, 1992.
- Joseph P. Carrozza Jr., MD1,
- Richard E. Kuntz, MD,
- Marc J. Levine, MD, FACC,
- Richard M. Pomerantz, MD,
- Robert F. Fishman, MD,
- Michael Mansour, MD,
- C.Michael Gibson, MD,
- Cynthia C. Senerchia, RN, MSN,
- Daniel J. Diver, MD, FACC,
- Robert D. Safian, MD, FACC and
- Donald S. Baim, MD, FACC∗
- ↵∗Address for correspondence: Donald S. Baim, MD, Cardiovascular Division, Beth Israel Hospital, 330 Brookline Avenue, Boston, Massachusetts 02215.
Objectives. The purpose of this study was to determine the immediate and long-term angiographic and clinical results of coronary stenting.
Background. Although preliminary trials of endovascular stenting have demonstrated promising results, lack of long-term follow-up has limited the critical evaluation of the role of coronary stenting in the treatment of obstructive coronary artery disease.
Methods. A total of 250 procedures using the Palmaz-Schatz stent, performed in 220 patients between June 1988 and July 1991, were examined. Minimal lumen diameter of the treated segments was measured on angiograms obtained before, after and 6 months after intervention.
Results. Stent placement was successful in 246 (98%) of 250 lesions, reducing diameter stenosis from 77% to −2.5%. There were nodeaths or Q wave myocardial infarctions. One patient (0.4%) required emergency bypass surgery and one (0.4%) developed subacute thrombosis. Femoral vascular complications occurred in 36 patients (16%).
Six-month angiographic follow-up was obtained in 91% of eligible patients. The overall angiographic restenosis rate (stenosis ≥50%) was 25%. By univariable analysis, the rate of restenosis was significantly higher for stents in the left anterior descending versus the right coronary artery (44% vs. 12%; p = 0.002); in diabetic patients (56% vs. 20%; p = 0.006), and in vessels with post-stent lumen diameter <3.31 mm (34% vs. 16%; p = 0.05). Stenting of the left anterior descending artery was the strongest predictor (p = 0.01) of restenosis in a multivariable model. Total survival was 97% and event-free survival (freedom from death, myocardial infarction or revascularization) was 70% at 36 months.
Conclusions. Palmaz-Schatz stents can be placed successfully with a low incidence of major complications. The angiographic restenosis rate was 25%, and 70% of patients remained free of cardiovascular events at 3 years. Diabetes, small postprocedure lumen diameter and stenting of the left anterior descending artery are associated with higher rates of restenosis.
- Received October 17, 1991.
- Revision received January 2, 1992.
- Accepted January 18, 1992.