Author + information
- Received July 14, 1995
- Revision received October 25, 1995
- Accepted November 14, 1995
- Published online April 1, 1996.
- Bruce D. Klugherz, MD,
- Debra L. DeAngelo, RN, MSN,
- Back K. Kim, MD,
- Howard C. Herrmann, MD, FACC,
- John W. Hirshfeld Jr., MD, FACC and
- Daniel M. Kolansky, MD, FACC1,*
- ↵*Address for correspondence: Dr. Daniel M. Kolansky, Cardiovascular Division, University of Pennsylvania Medical Center, 3400 Spruce Street, Philadelphia, Pennsylvania 19104.
Objectives. Our goals were to examine late clinical outcome in a cohort of patients who electively received Palmaz-Schatz intracoronary stents, to identify specific predictors of outcome and to determine the time course of the development of ischemic cardiac events after stenting.
Background. Short-term results of Palmaz-Schatz intracoronary stenting have been promising, with a reduction in both angiographic restenosis and clinical cardiac events up to 1 year after stenting.
Methods. We analyzed the clinical outcomes in 65 consecutive patients who underwent stenting at least 3 years before analysis. Demographic, clinical and procedural predictors of survival and event-free survival, defined as freedom from myocardial infarction, stent-site percutaneous transluminal coronary angioplasty, coronary artery bypass graft surgery or death, were analyzed at a mean follow-up of 39 ± 17 months.
Results. Absolute survival and event-free survival at 3 years were 88% and 56%, respectively. Three-year freedom from stentsite revascularization was 66%. Predictors of decreased long-term survival (p < 0.05) included diabetes and a high angina score (Canadian Cardiovascular Society class III/IV) at 6 and 12 months after stenting. Predictors of decreased event-free survival (p < 0.05) included a high angina score at 3, 6 and 12 months after stenting, smaller stent deployment balloon size and greater number of stents implanted. Freedom from adverse events by 6 months after stenting also correlated with long-term event-free survival. Eighty-five percent of stent-site revascularizations occurred within 1 year. During late follow-up (>24 months), no patients had stent-site stenoses requiring revascularization, whereas 11% of patients required revascularization in nonstented coronary segments.
Conclusions. Clinical predictors of worse long-term outcome included diabetes mellitus, higher angina score at follow-up, smaller stent deployment balloon size and greater number of stents at implantation. During follow-up, the majority of adverse events and stent-site revascularizations occurred early after stenting, and disease progression in nonstented vessels accounted for the majority of late revascularization events.
- Received July 14, 1995.
- Revision received October 25, 1995.
- Accepted November 14, 1995.
- American College of Cardiology