title: Clinical and angiographic outcome after Palmaz-Schatz stent implantation guided by intravascular ultrasound.
abstract: Intracoronary stents can be implanted with a low incidence of stent thrombosis (< 1%) when the stent procedure is guided by intravascular ultrasound. The long-term clinical and angiographic effects, however, have not been reported. This study assesses the 6 month clinical and angiographic results of a consecutive series of patients with intravascular ultrasound guided Palmaz-Schatz stent deployment that were not treated with subsequent anticoagulation after a successful stent implantation procedure. From March, 1993 to April 1994, 411 patients underwent Palmaz-Schatz stent implantation. There were 26 patients that had uncomplicated Palmaz-Schatz stent implantation that were treated with a standard anticoagulation regimen that are not evaluated in this study. Thus, this study includes an assessment of 385 patients that had either a successful intravascular ultrasound guided stent implantation procedure and did not receive post procedure anticoagulation or had a procedural complication. Procedural success was achieved in 369 patients (96%). Clinical success (procedure success without early post procedure event) was achieved in 363 patients (94%). There were 2 acute stent thrombosis events (0.5%) and 1 subacute stent thrombosis (0.3%) in the group of 369 patients with 454 lesions treated without anticoagulation. At 6 month clinical follow-up the incidence of myocardial infarction was 4.9% and the rate of coronary bypass surgery was 6.2%. There was a 2.1% incidence of death. Emergency intervention (emergency angioplasty or bailout stent implantation was necessary in 3 patients (0.8%). The total incidence of repeat percutaneous intervention was 11.4%. By 6 months clinical follow-up, major events had occurred in 19.2% of patients. The angiographic lesion restenosis rate, according to 50% diameter stenosis criteria, was 19%. The incidence of restenosis per patient was 22%. In conclusion, intravascular ultrasound guided Palmaz-Schatz can be performed without subsequent anticoagulation with a low incidence of stent thrombosis and acceptable clinical and angiographic outcome at 6 month clinical follow-up.
authors.affiliation: Centro Cuore Columbus, Milan, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Hall
authors.forename: S
authors.initials: S
authors.lastname: Nakamura
authors.forename: L
authors.initials: L
authors.lastname: Maiello
authors.forename: Y
authors.initials: Y
authors.lastname: Almagor
authors.forename: A
authors.initials: A
authors.lastname: Gaglione
authors.forename: S L
authors.initials: SL
authors.lastname: Goldberg
authors.forename: J M
authors.initials: JM
authors.lastname: Tobis
authors.forename: G
authors.initials: G
authors.lastname: Martini
authors.forename: G
authors.initials: G
authors.lastname: Tucci
authors.forename: M
authors.initials: M
authors.lastname: Di Maggio
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D003328:Coronary Thrombosis / Q000453:epidemiology / Q000517:prevention & control; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D012008:Recurrence; D015607:Stents / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional