Author + information
- Received November 12, 1996
- Revision received April 28, 1997
- Accepted May 16, 1997
- Published online July 1, 1997.
- Verghese Mathew, MDA,
- David Hasdai, MDA,
- David R Holmes, MD, FACC, Jr.A,
- Kirk N Garratt, MD, FACCA,
- Malcolm R Bell, MBBS, FACCA,
- Amir Lerman, MD, FACCA,
- Steven Melby, RNA,
- Diane E Grill, MSA and
- Peter B Berger, MD, FACCA,*
- ↵*Dr. Peter Berger, Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905. E-mail: email@example.com.
Objectives. We sought to evaluate the outcome of patients undergoing multiple (three or more), contiguous stent implantation within a single native coronary artery.
Background. The implantation of multiple stents within a single coronary artery is increasing in frequency, although the outcome of such patients is not well described.
Methods. Forty-five patients without previous coronary artery bypass graft surgery (CABG) undergoing multiple, contiguous stent implantation in a single coronary artery were identified. Clinical and angiographic characteristics and outcomes were analyzed.
Results. The angiographic success rate was 97.8%. The procedural success rate was 91.1%; stent occlusion during the initial hospital period occurred in four patients (8.9%). Death, myocardial infarction (MI), CABG, repeat target vessel intervention or severe angina occurred in 10 (23.3%) of 43 hospital survivors at 6-month follow-up. The indication for stent placement was threatened or abrupt closure in 30 patients (66.7%). Of the 25 patients with abrupt or threatened closure whose clinical and angiographic data would have indicated emergent CABG had stents not been available, the frequency of in-hospital death and Q wave MI was similar to that of a matched consecutive series of patients at our institution who underwent emergent CABG after failed angioplasty. At 1 year, the frequency of death, Q wave MI, CABG and severe angina at 1 year was similar in the two groups; the need for repeat percutaneous intervention was more common in the stent group (25% vs. 0%, p = 0.01).
Conclusions. Implantation of multiple, contiguous intracoronary stents was associated with a high initial success rate, although the incidence of early stent closure was relatively high. Adverse events at 6 months of follow-up were more frequent than previously reported for elective single-stent implantation; however, adverse angiographic characteristics such as dissection and thrombus were frequent in this group. In addition, the strategy of multiple stent implantation in the setting of failed angioplasty is a reasonable alternative to emergent CABG, although the need for further percutaneous intervention must be anticipated.
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This study was presented in part at the 46th Annual Scientific Session of the American College of Cardiology, Anaheim, California, March 1997.
- Received November 12, 1996.
- Revision received April 28, 1997.
- Accepted May 16, 1997.