ABSTRACT
Objective Diameter of the affected coronary artery is an important predictor of restenosis and need for revascularization. In the present study, we investigated the frequency and potential risk factors for major adverse cardiac events following elective percutaneous coronary intervention (PCI) and stenting of large coronary arteries. Methods We reviewed the data of elective candidates of PCI on a large coronary artery who presented to our center. Demographic, clinical, angiographic and follow-up data of the eligible patients were retrieved from our databank. The study characteristics were then compared between the patients with and without MACE in order to find out the probable risk factors for MACE in patients with large stent diameter. Results Data of 3043 patients who underwent single vessel elective PCI with a stent diameter of ≥3.5 mm was reviewed. During a median follow up period of 14 months, 64 (2.1%) patients had MACE. TVR was the most common type of MACE that was observed in 29 patients, while 5 patients had cardiac death. Higher serum levels of creatinine, history of cerebrovascular accident (CVA), and use of a drug eluting stent (DES) were significantly associated with MACE. In the multivariate model, history of CVA (odds ratio = 5.23, P = 0.030) and use of DES (odds ratio = 0.048, P = 0.011) were the independent predictors of MACE in patients underwent large coronary artery stenting. Conclusion This study showed that prior CVA and the use of BMS were the potential risk factors for MACE in patients who were stented on their large coronary arteries.
ABSTRACT
BACKGROUND: Direct stenting without balloon dilatation may reduce procedural costs and duration, and hypothetically, the restenosis rate. This study was designed to compare the in-hospital and long-term outcomes of direct stenting (DS) versus stenting after predilatation (PS) in our routine clinical practice. METHODS: One thousand six hundred and three patients treated with stenting for single coronary lesions were enrolled into a prospective registry. Patients with acute myocardial infarction (MI) within the preceding 48 hours, highly calcified lesions, total occlusions, or lesion in a saphenous graft were excluded. The baseline, angiographic, and procedural data, in-hospital outcomes and follow-up data were recorded in our database, and analyzed with appropriate statistical methods. RESULTS: Eight hundred and fifty-seven patients (53.5%) were treated with DS, whereas 746 of them (46.5%) underwent PS. In the DS group, lesions were shorter in length, larger in diameter, and had lower pre-procedural diameter stenosis. Type C and diffuse lesions and drug-eluting stents were less frequent (p < 0.001). In univariate analysis, dissection and non-Q-wave MI occurred less frequently in this group (0.2% and 0.6% vs 3.9% and 2.1%, p < 0.001 and p 7 = 0.01, respectively). However, the cumulative major adverse cardiac events (MACE) did not differ significantly (4.9% vs 4.6%, p = 0.79). In multivariate analysis, direct stenting reduced the risk of dissection (OR = 0.07, 95% CI: 0.01-0.33), but, neither the cumulative endpoint of MACE (OR = 1.1, 95% CI = 0.58-2.11, p = 0.7) nor its constructing components were different between the groups. CONCLUSIONS: Direct stenting in real world has at least similar long-term outcomes with patients treated with stenting after predilatation and is associated with lower dissection rate.