ABSTRACT
HYPOTHESIS: This study was designed to investigate the clinical and angiographic features and procedural outcomes of small-vessel stenting in a real-world experience during the transition era between drug-eluting stents (DES) and bare-metal stents (BMS). METHODS: Using one of the largest single-institutional cohorts, this study evaluated all patients who underwent percutaneous coronary intervention (PCI) from 2002 through 2005. Analysis was restricted to patients receiving a single stent or undergoing balloon-only angioplasty in a single anatomic site. Small-vessel stents (SVS) were defined as 2.00 to 2.75 mm and large-vessel stents (LVS) as 3.00 to 4.00 mm in diameter. RESULTS: A total of 19,580 stents were placed in 10,396 patients. Of 6208 patients fulfilling inclusion criteria, 1630 (26.3%) received SVS, and 4578 (73.7%) received LVS. The SVS group had more female (35.5% vs 26.3%, P < .001) and diabetic patients (27.9% vs 24.2%, P < .003) than the LVS group. Compared with LVS, SVS lesions were shorter (14.5 +/- 5.8 mm vs 15.7 +/- 6.4 mm, P < .0001) and more complex (66% vs 53% class B2/C lesions, P = .041). Indicators of procedural difficulty, including greater contrast volume, number of devices, total inflation time, and fluoroscopy time, were more commonly observed in the SVS group. After adjustment for confounding factors, the incidence of small treatment vessel diameter was significantly higher among the DES vs the BMS group (odds ratio [OR]: = 1.94, 95% confidence interval [CI]: 1.56-2.36). CONCLUSIONS: In addition to identifying distinct patient, lesion, and procedural performance characteristics, our study, one of the largest single-center experiences in small-vessel PCI, suggests that the availability of DES substantially increased the use of SVS, as opposed to balloon-only angioplasty, in this anatomically challenging setting.
Subject(s)
Angioplasty, Balloon, Coronary/instrumentation , Coronary Angiography , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/therapy , Drug-Eluting Stents , Metals , Stents , Aged , Angioplasty, Balloon, Coronary/adverse effects , Cohort Studies , Female , Humans , Logistic Models , Male , Middle Aged , Odds Ratio , Prosthesis Design , Registries , Risk Assessment , Risk Factors , Severity of Illness Index , Treatment OutcomeABSTRACT
Spontaneous coronary artery dissection (SCAD) is a potentially life-threatening entity with a variety of clinical presentations. We report a patient who presented with chest pain and angiographic evidence of coronary dissection. Due to the rapid resolution of symptoms and benign-appearing nature of the dissection, no intervention was pursued and the patient was maintained on medical therapy. She represented 2 days later with substernal chest pain, dynamic EKG changes, positive cardiac biomarkers and a transient depression of her left ventricular function.
