Clinical and angiographic outcome after angiography-guided stent placement in small coronary vessels.
BACKGROUND
Although it is widely accepted that stenting confers favorable angiographic and clinical results in coronary arteries >/=3.0 mm in diameter, the outcome of stent placement in smaller vessels remains largely unclear.


RESULTS
We sought to specifically determine the early and long-term clinical outcomes in a large series of 197 consecutive patients who underwent stent placement in 207 vessels <3.0 mm in diameter. Procedural success, accomplished in 97.3%, was accompanied by a significant reduction in lesion severity from 85% +/- 9% before to 3% +/- 7% diameter stenosis after the procedure (P =.0001) and a 0.5% incidence of subacute stent thrombosis. At 1 and 2 years of follow-up, survival rate without major target lesion-driven events was observed in 77.3% and 73.9% of patients, respectively. Repeat revascularization procedures accounted for most of these events; cardiac deaths (including those related to subacute stent thrombosis) and late (>30 days) myocardial infarctions were infrequent (2.4% and 1.0%, respectively). The 6-month angiographic binary instent restenosis rate was 30.1%. On multivariate analysis, diabetes mellitus (P =. 0275), small baseline reference vessel size (P =.0300), and stent size </=2.7 mm (P =.0111) were independently associated with an increased instent restenosis rate.


CONCLUSIONS
Optimal angiography-guided coronary stenting of vessels <3.0 mm in diameter in association with the stringent use of a poststent combined aspirin-ticlopidine antiplatelet regimen confers a low risk of stent thrombosis, an acceptable incidence of angiographic instent restenosis, and a favorable long-term clinical outcome.
Lau
K W
KW
National Heart Centre of Singapore, Singapore. LAU_Kean_Wah@nhc.com.sg
Ding
Z P
ZP
Sim
L L
LL
Sigwart
U
U
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D017023:Coronary Angiography / Q000295:instrumentation*; D003327:Coronary Disease / 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; D012008:Recurrence; D012307:Risk Factors; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome