title: Major clinical events after coronary stenting. The multicenter registry of acute and elective Gianturco-Roubin stent placement. The Gianturco-Roubin Intracoronary Stent Investigator Group.
abstract: BACKGROUND
  Abrupt vessel closure and early reocclusion remain the principal vascular events underlying early recurrent ischemia complicating elective percutaneous transluminal coronary angioplasty (PTCA). Intracoronary stenting has been used to circumvent emergency bypass surgery after acute vessel closure and as an adjunct for the elective treatment of restenosis. The initial multicenter experience with the Gianturco-Roubin stent is presented, and predictors for early recurrent ischemic events are identified.
  
  
  RESULTS
  Data accrued from 639 serial patients undergoing emergency stenting for abrupt closure (n = 415; 65%) or elective deployment for restenosis (n = 224; 35%) from October 1989 through May 1991 were analyzed. The incidence of subsequent ischemic events, including death, nonfatal myocardial infarction, and bypass surgery referral within 90 days of the procedure, was higher after acute deployment (20%) compared with elective stenting (9%; P = .0004). Although mortality within the two cohorts was the same (3%; P = NS), there were significant differences in the incidence of nonfatal myocardial infarction (5% versus 0.5%; P = .002) and bypass surgery (12% versus 6%; P = .02) between the acutely and electively stented patients, respectively. These events were significantly more common when the stent was undersized to the target vessel diameter (stent:artery ratio for event, 0.95 +/- 0.14 versus no event, 1.04 +/- 0.22; P = .0001) or when there was less expansion of the lesion by the deployed device (stent-to-lesion diameter ratio for event, 6.6 +/- 9.2 versus no event, 11.0 +/- 21.4; P = .0001). In a stepwise logistic regression model, acute stenting (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.3 to 2.4), multivessel disease (OR, 1.4; CI, 1.1 to 1.8), larger target lesion diameter (OR, 2.1; CI, 1.4 to 3.2), larger target vessel (OR, 2.9; CI, 1.7 to 4.7), and smaller stent size (OR, 6.1; CI, 3.0 to 12.3) were independent predictors of early, recurrent ischemic events. The presence of thrombus was associated with a higher event rate after elective stenting (OR, 2.3; CI, 1.06 to 5.4) but was not associated with a higher early event rate after acute stenting.
  
  
  CONCLUSIONS
  Early ischemic events are more common after acute stenting for abrupt or threatened closure than after elective deployment. These events may be avoided with careful attention to morphometric characteristics to avoid undersizing the stent to the target vessel and ensure adequate lesion expansion.
authors.affiliation: Department of Cardiology, Cleveland Clinic Foundation, OH 44195-5001.
authors.forename: J M
authors.initials: JM
authors.lastname: Sutton
authors.forename: S G
authors.initials: SG
authors.lastname: Ellis
authors.forename: G S
authors.initials: GS
authors.lastname: Roubin
authors.forename: C A
authors.initials: CA
authors.lastname: Pinkerton
authors.forename: S B
authors.initials: SB
authors.lastname: King
authors.forename: A E
authors.initials: AE
authors.lastname: Raizner
authors.forename: D R
authors.initials: DR
authors.lastname: Holmes
authors.forename: D J
authors.initials: DJ
authors.lastname: Kereiakes
authors.forename: E J
authors.initials: EJ
authors.lastname: Topol
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003327:Coronary Disease / Q000453:epidemiology / Q000628:therapy*; D004630:Emergencies; D004867:Equipment Design; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000453:epidemiology*; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D013193:Stainless Steel; D015607:Stents; D013997:Time Factors
chemical_list: D013193:Stainless Steel