Comparison of results of intracoronary stenting in patients with unstable vs. stable angina.
Percutaneous transluminal coronary angioplasty (PTCA) has higher complication and restenosis rates when performed in the setting of unstable angina. Balloon-expandable intracoronary stenting is a new technique with the potential to improve the results of PTCA. In order to determine whether stenting is associated with a poorer outcome in patients with unstable angina, we retrospectively examined our experience with the Palmaz-Schatz balloon-expandable intracoronary stent in 105 patients. Patients were divided into 2 groups on the basis of symptoms at the time of stent insertion: group I (n = 57) had stable angina pectoris, and group II (n = 48) had unstable angina defined as pain at rest despite antianginal therapy (Braunwald class II, III). Initial (30-d) and final (6-mo) success rates were defined as stent insertion without myocardial infarction, need for bypass surgery, death, and significant angina. Baseline characteristics were similar, although the patients with unstable symptoms were older, more likely to be female, and had a higher incidence of postinfarction angina. A total of 136 stents were successfully delivered to 97 target sites in 92% of patients. Major complications occurred in 4 patients (4%) and were due to subacute thrombosis in 3 of them. There were no differences in complication rates between patients receiving stents electively with stable vs. unstable symptoms (2% vs. 6%, p = NS). Six-mo. follow-up status was ascertained in 96% of patients and revealed overall clinical success in 83% with angiographic restenosis (> or = 50% stenosis) in 28% of patients. There were no significant differences between groups in rates of restenosis, follow-up angina class, or overall clinical success.(ABSTRACT TRUNCATED AT 250 WORDS)
Malosky
S A
SA
Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia 19104.
Hirshfeld
J W
JW
Herrmann
H C
HC
D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D000789:Angina, Unstable / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D010043:Outcome and Process Assessment, Health Care; D012008:Recurrence; D015607:Stents