Comparison of three coronary stents: Clinical and angiographic outcome after elective placement in 134 consecutive patients (original) (raw)
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Catheterization and Cardiovascular Diagnosis, 1992
We studied 100 patients who had coronary implantation of Palmaz-Schatz stents in our institution from November 1989 until March 1991. A total of 126 standard and 6 short stents were implanted. The patients' mean age was 58 ± 5 years, and 97 were males. The indications were lesions with high risk of restenosis (29 patients), restenosis (27 patients), suboptimal result of angioplasty (24 patients), dissection (16 patients), and recanalized chronic total occlusion (6 patients). In 17 patients a brachial cut-down approach was used. Stents were correctly placed in 98 patients. Stent related complications occurred in 9 patients: major ischemic complications in 7 patients (acute myocardial infarction in 2 patients, emergency bypass surgery in 3 patients and emergency angio-plasty in 2 patients); in 3 of these patients there was a subacute closure of the stent and in 2 patients there were delivery problems. Vascular complications at the site of arterial puncture occured in 3 patients (some patients had more than one complication). A learning curve was observed. There was a decrease in the complication rate with the higher number of patients treated: 28% for the first 50 patients and 6% for the last 50 patients. Clinical follow-up was available in all patients. Of the 92 patients eligible for follow-up (7 ± 2 months), 69 patients were asymptomatic and 23 had recurrence of angina: 19 patients for stent restenosis and 4 patients for coronary artery disease progression. Follow-up angiogram was done in 79/92 (86%) patients: 21 had restenosis (27%). Restenosis rate was higher in patients with multiple stents 40% (6/15) than with the single stent 23% (15/64), and when the indications were for dissection 35% (6/17). These differences did not reach statistical significance. The global incidence of restenosis appears to be lower when compared to balloon coronary angloplasty, although there is no garantee these populations are comparable. Stenting seems to be a good alternative to coronary angioplasty in lesions which are not considered ideal for the balloon dilatation and to treat occlusive dissections. The use of multiple and partial overlapping stents is associated with a high restenosis rate. These impressions need to be tested in a large, randomized, multicenter study. © 1992 Wiley-Liss, Inc.
Long-Term Follow-Up After Angiographically Successful Coronary Stenting
Japanese Heart Journal, 2004
The purpose of the study was to compare the impacts of angiographically successful direct stent implantation and conventional stent implantation (stent implantation following predilatation) on long-term major cardiac events. The authors prospectively studied 40 patients who had successful direct stent implantation and 46 patients who had successful conventional stent implantation. The end-point of the study was defined as the occurrence of a major cardiac event, including recurrent angina, acute myocardial infarction, death, and target vessel revascularization. The demographic and clinical characteristics of the study groups were similar, except the indication of percutaneous angioplasty, which was more frequently unstable angina in the conventional stent group (63% vs 38%, P: 0.03). Procedural minor complications were more frequent in conventional stent implantation, and there was also a positive correlation between the conventional stent implantation and procedural minor complications (r = 0.231, P: 0.03), and postprocedural troponin elevation (r = 0.221, P: 0.04). The incidences of major cardiac events including recurrent angina, acute myocardial infarction, death, death or myocardial infarction, and target vessel revascularization were not different between the study groups during the long-term follow-up period (21 ± 7.1 months for direct stent group and 20 ± 7.5 months for conventional stent group). Overall end-points occurred in 9 patients (22%) in the direct stent group and in 9 patients (19%) in the conventional stent group. Kaplan-Meier survival analysis showed that there was no difference in event-free survival between the patients treated with direct stent implantation and conventional stent implantation (log-rank: 1.52, P = 0.21). Two-vessel intervention and hypertension were found to be related with long-term major cardiac events (r = 0.214, P: 0.048, r = 0.206, P: 0.04, respectively). In addition to the procedural advantages, direct stent implantation may also provide comparable results with conventional stent implantation concerning the late cardiac events following successful percutaneous coronary angioplasty.
Circulation, 2000
Background-This prospective multicenter randomized clinical trial was designed to evaluate the long-term angiographic and clinical outcomes of elective treatment with the GR-II stent compared with the Palmaz-Schatz (PS) stent in patients with coronary stenoses. Methods and Results-Seven hundred fifty-five patients with myocardial ischemia and de novo native coronary stenoses in 3-to 4-mm vessels were randomly assigned to the PS (375 patients) or the GR-II stent (380 patients). The primary end point was 12-month target lesion revascularization (TLR)-free survival. Angiography was performed at baseline and at follow-up in the first 300 consecutive patients to assess the frequency of angiographic restenosis. Procedure success was 98.5% for the GR-II stent and 99.4% for the PS stent (Pϭ0.19). At 30 days, patients assigned to the GR-II stent had a higher stent thrombosis rate (3.9% versus 0.3% for PS stent, PϽ0.001) and TLR rate (3.9% versus 0.5% for PS stent, PϽ0.001). The GR-II group had a higher follow-up restenosis frequency (47.3% versus 20.6% for the PS group, PϽ0.001) and a lower 12-month TLR-free survival rate (71.7% versus 83.9% for the PS group, PϽ0.001). Multivariate logistic regression analysis identified a smaller final stent minimal lumen diameter (odds ratio [OR] 2.49, 95% CI 1.56 to 3.98; PϽ0.001), diabetes mellitus (OR 2.14, 95% CI 1.42 to 3.22; PϽ0.001), and use of the GR-II stent (OR 1.78, 95% CI 1.20 to 2.64; PϽ0
Catheterization and Cardiovascular Interventions, 2004
The present study reports the results of the short-and long-term outcomes of prospective uni-and multicenter stent registries: Palmaz-Schatz (n ؍ 140 patients), Ave-Micro and GFX (n ؍ 280), Multilink Duet (n ؍ 340), Multilink Tetra (n ؍ 192), and Carbo (n ؍ 140) Stent Registries, as well as the predictors and angiographic cutoff points predicting major adverse cardiac events (MACE) after different stent implantations. Significant decrease in subacute stent thrombosis (from 2.9% to 0) and MACE (from 35% to 8.3%) occurred as the improved stents, optimized stent implantation technique, and new postintervention drug therapy were introduced. The changes of angiographic cutoff values (postintervention minimal lumen diameter and preintervention reference diameter: from 2.9 and 3.1 mm for Palmaz-Schatz to 2.5 and 2.8 mm for Multilink Duet, Multilink Tetra, and Carbo stents) and clinical and angiographic factors predicting MACE indicated the change of traditional restenosis paradigm and that progress in clinical practice might be able to counterbalance unfavorable lesion and intervention-related characteristics.
Clinical experience with the Palmaz-Schatz coronary stent. Initial results of a multicenter study
Circulation, 1991
Stenting of native coronary arteries with a balloon-expandable stent was attempted in 226 patients after elective angioplasty. Delivery of the device was successful in 213 (94%) of the patients. Of these, 39 received aspirin and dipyridamole only (group 1) and 174 received aspirin, dipyridamole, and warfarin for 1-3 months (group 2). There was no abrupt closure (less than or equal to 1 day) or perioperative death in either group. In-hospital or perioperative complications in group 1 compared with group 2 were as follows: subacute closure (1-14 days), seven (18%) patients versus one (0.6%) patient, respectively, p less than 0.0001; myocardial infarction, five (13%) patients versus one (0.6%) patient, respectively; condition requiring urgent bypass surgery, one (2.5%) patient versus no patients, respectively. Thus, the incidence of major complications such as death, myocardial infarction, or a condition requiring urgent bypass surgery was 15% in group 1 and 0.6% in group 2. Clinical f...
Long-term (≥8 years) outcome after palmaz-schatz stent implantation
American Journal of Cardiology, 2001
The purpose of this single-center study was to evaluate the long-term (>8 years) outcome of Palmaz-Schatz intracoronary stenting and to identify independent predictors of outcome. Although short-term results of Palmaz-Schatz intracoronary stenting have been promising, with a reduction in both angiographic restenosis and clinical cardiac events up to 3 years, longer-term follow-up has not been established. We analyzed clinical outcome in 426 consecutive patients at least 8 years after coronary stenting. Demographic, clinical, and procedural predictors of restenosis, survival, and event-free survival, defined as freedom from death, myocardial infarction (MI), and coronary revascularization (target stented site, target vessel, and any revascularization) were analyzed. Before discharge, 28 patients (6.6%) sustained at least 1 major cardiovascular event: 3 deaths (0.7%), 18 MIs (4.2%), and 17 repeat revascularizations. Surviving patients were followed for 8.9 years (interquartile range 8.4 to 9.4). After discharge, 59 patients (13.9%) died, 47 (11.1%) sustained an MI, and 188 (44.4%) underwent coronary revascularization. The 8-year event-free survival (freedom from death, freedom from death/MI/ target-stented site revascularization, and freedom from death/MI/any coronary revascularization) was (mean ؎ SE) 0.86 ؎ 0.01, 0.62 ؎ 0.03, and 0.47 ؎ 0.02, respectively. Unstable angina, lower left ventricular ejection fraction, and saphenous vein graft stenting were found to be independent predictors of death during follow-up. Hypertension, unstable angina, multivessel disease, and multiple stent implantation were found to be independent predictors of the composite of death/ MI/any coronary revascularization during follow-up. This study provided a useful assessment of very longterm outcome in survival, event-free survival, and predictors of major cardiac events 8 to 10 years after Palmaz-Schatz stent implantation. ᮊ2001 by Excerpta Medica, Inc.
Practical Clinical Evaluation of Stents
Journal of Interventional Cardiology, 1998
This article discusses the clinical issues pertaining to an optimal stenting result and analyzes relevant stent structures and functions. There are five components of optimal stenting: favorable clinical features, easy stent deliver?/, ideal scaffolding, low stent thrombosis, and low restenosis. In straightforward cases, such as stenting in the mid-right coronary artery with a straight proximal segment, procedural success can be achieved with any stent. In vessels with curved, tortuous proximal segments, a highly flexible stem is needed for a smooth and successful delivety For ostial, protected lefi main, or aortoanastomotic lesions, stents with suficient radial strength and good visibility are needed. The two major concerns of an interventional cardiologist choosing a stent are excellent trackability for fast delivery and low long-term restenosis rate. In all situations, the procedural success depends on the operator's manual dexterity, experience with a particular stent design, and critical evaluation of different structural stent features to maximize benefits. Any new stent with high longitudinalflexibility, excellent scaffolding and radial strength, adequate radiopacity, complete deployment after one inflation, and that is easily recrossed and provides a good symmetrical conduit for a smooth coronaryjlow resulting in little tendenq for thrombosis or restenosis would be today's stent of choice.