Safety and efficacy of coronary stent implantation. Acute and six month outcomes of 1,126 consecutive patients treated in 1996 and 1997

Abstract

Original ArticlePurpose -The authors analyzed the 30-day and 6-month outcomes of 1,126 consecutive patients who underwent coronary stent implantation in 1996 and 1997. MI (1.3% vs 1.1%, 1996 vs 1997, emergency coronary bypass surgery (1% vs 0.6%, 1996(1% vs 0.6%, vs 1997 and 30-day death rates (0.2% vs 0.5%, 199630-day death rates (0.2% vs 0.5%, vs 1997 were similar. The 6-month restenosis rate was 25% in 1996 and 27% in 1997 (p= NS); the target vessel revascularization rate was 15% in 1996 and 16% in 1997 (p = NS). In the first years of its usage, randomized trials and many consecutive series of patients showed higher rates of thrombotic occlusion after coronary stent implantation (5 to 20%). This adverse event stimulated the use of one of the most severe antithrombotic drug regimens ever applied in interventional cardiology in an attempt to reduce the incidence of this major coronary complication. However, the series of procedures that followed this pharmacological approach did not demonstrate a reduction in the subacute occlusion rates, and major bleeding, a serious side effect, occurred. It is natural to conclude that this approach resulted in longer hospital stays with increasing costs, making physicians leery of recommending this new percutaneous coronary revascularization method 2-3 . Methods -The 30-day results and 6-month angiographic follow-up were analyzed in patients treated with coronary stents in 1996 and 1997. All patients underwent coronary stenting with high-pressure implantation (>12 atm) and antiplatelet drug regimen (aspirin plus ticlopidine). Results ConclusionsThe scenario changed, however, with the publication of the results of two major randomized studies in 1994, which compare balloon PTCA with stents. The comparison demonstrates that, stents can create significancy higher coronary lumen diameters, reduce the restenosis rate at the end of the first 6 months and as a consequence the need for further revascularization procedures, percutaneous or surgical, compared with the standard balloon PTCA method [4][5][6][7] . In 1995, Colombo et al 8 demonstrated that intravascular ultrasound could optimize stent delivery and implantation, applying higher balloon pressures (>12 ATM), promoting better stent symmetry, with a nearly full

Predictive factors of complications after coronary stent implantation

“…The index of clinical success in this study is comparable to those in several previous studies, considering the differences in the criteria of success and major cardiovascular complications used (in our study, the need for a new percutaneous intervention in the in-hospital phase or in the first month due to subacute thrombosis was considered a major complication) 1,5,11,25,26 . Some randomized clinical assays have reported rates of success of up to 99%, but in groups of patients at very low risk, excluding ongoing acute myocardial infarction and patients with unfavorable angiographic criteria 21 .…”

Influence of balloon pressure inflation in patients undergoing primary coronary stent implantation during acute myocardial infarction: a quantitative coronary angiography analysis

“…This finding is because of the more recent availability of customized sizes for stents (fig. 1) 27 . This fact was strictly related to a temporal trend in stent availability, rather than the occurrence of stent implantation failure in the patients randomized to group 2 (edge dissections).…”

“…All stents were implanted with previous balloon predilation (6 to 10 atm). Only the infarctrelated artery was treated with coronary stenting 27 .…”

Less Is More: Developments in Nanotechnology for Antirestenosis Therapies

“…6–8 Coronary drug-eluting stents (DESs) were first implanted in 1999 with Food and Drug Administration (FDA) approval following in the early 2000s. 9,10 DES were coated with taxane- or limus-based antiproliferative drugs to limit neointimal hyperplasia associated with restenosis and reduce lesion revascularization rates by targeting the mitotic pathways involved in unregulated SMC growth. Stent design was also improved, incorporating thinner struts and lightweight materials like cobalt-chromium.…”