title: Immediate and late outcomes after direct stent implantation without balloon predilation.
abstract: OBJECTIVE
  The aim of our study was to compare the in-hospital and long-term clinical outcomes of direct coronary stenting with balloon predilation followed by stent placement.
  
  
  BACKGROUND
  With improvement in stent designs, the practice of direct stenting without balloon predilation has become more widespread.
  
  
  METHODS
  We analyzed the Mayo Clinic Coronary Intervention data base between January 1, 1995 and March 5, 1999 and identified 777 patients who were treated with direct stenting (DS) and 3,176 patients treated with balloon angioplasty plus stenting (BA+S).
  
  
  RESULTS
  The procedural success rates between the DS and BA+S groups were not significantly different (96.3% vs. 96.4%). The ability to deliver the stent in a subgroup of patients who had DS was 95%, with 5% requiring crossover to predilation. Multivariate analysis showed no significant differences with respect to in-hospital death (odds ratio [OR] 0.9, 95% confidence interval [CI] 0.5 to 1.8), in-hospital myocardial infarction (OR 0.9, 95% CI 0.6 to 1.2) or revascularization (OR 0.7, 95% CI 0.4 to 1.5) in the DS compared with the BA+S group. Long-term outcomes were not significantly different between the DS and BA+S groups. The procedural duration was significantly shorter in the DS group, and there was a decreased utilization of contrast agent, balloons and wires.
  
  
  CONCLUSIONS
  The in-hospital and long-term clinical outcomes in patients undergoing a coronary intervention are equivalent when comparing stenting without balloon predilation with balloon angioplasty followed by stenting. Direct stenting is associated with decreased utilization of contrast agent and equipment and shorter procedure times. A randomized study should be performed to better determine the impact of this technique on short- and long-term procedural outcomes.
authors.affiliation: Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
authors.forename: S H
authors.initials: SH
authors.lastname: Wilson
authors.forename: P B
authors.initials: PB
authors.lastname: Berger
authors.forename: V
authors.initials: V
authors.lastname: Mathew
authors.forename: M R
authors.initials: MR
authors.lastname: Bell
authors.forename: K N
authors.initials: KN
authors.lastname: Garratt
authors.forename: C S
authors.initials: CS
authors.lastname: Rihal
authors.forename: J F
authors.initials: JF
authors.lastname: Bresnahan
authors.forename: D E
authors.initials: DE
authors.lastname: Grill
authors.forename: S
authors.initials: S
authors.lastname: Melby
authors.forename: D R
authors.initials: DR
authors.lastname: Holmes
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate