title: Evolution in the practice of primary angioplasty: effect of adjunctive coronary stenting and glycoprotein IIb/IIIa inhibitors on long-term outcomes.
abstract: Primary angioplasty strategies have evolved dramatically, including increasing adjunctive use of stents and glycoprotein (GP) IIb/IIIa inhibitors. The purpose of this study was to examine the specific effects of these adjunctive therapies on long-term outcomes after primary angioplasty. From 1996 to 1998, 257 unselected, consecutive patients underwent primary PTCI at our institution. In-hospital mortality was 5.4% (2.9% for patients without cardiogenic shock). The remaining 243 patients were followed for 2.0 +/- 0.7 years. Adjunctive stenting was associated with increased late mortality (8.7% vs. 2.3%, P = 0.02). GP IIb/IIIa inhibitors were associated with reduced late mortality among patients receiving stents (6.9% vs. 21.4%, P = 0.07), but not in those patients treated with balloon angioplasty alone (2.9% vs. 0%, P > 0.20). Coronary stenting remained a significant predictor of late mortality (hazard ratio 5.6, 95% CI 1.5-21.2) after adjustment for other established risk factors. In this unselected series, adjunctive coronary stenting was associated with higher late mortality among hospital discharge survivors. Concomitant GP IIb/IIIa inhibitors partially corrected for this increase. These results are limited by the small sample size and retrospective design of this study. Additional long-term studies are required to test these findings and evaluate for possible mechanisms.
authors.affiliation: Cardiology Unit, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA.
authors.forename: V G
authors.initials: VG
authors.lastname: Kalaria
authors.forename: I
authors.initials: I
authors.lastname: Chaudhary
authors.forename: S
authors.initials: S
authors.lastname: Jacobson
authors.forename: R M
authors.initials: RM
authors.lastname: Pomerantz
authors.forename: C J
authors.initials: CJ
authors.lastname: Cove
authors.forename: F S
authors.initials: FS
authors.lastname: Ling
authors.forename: D E
authors.initials: DE
authors.lastname: Cutlip
mesh_terms: D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000639:trends*; D003131:Combined Modality Therapy / Q000639:trends; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000628:therapy; D009518:New York / Q000453:epidemiology; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors / Q000627:therapeutic use; D011237:Predictive Value of Tests; D012008:Recurrence; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000150:complications / Q000401:mortality; D015607:Stents / Q000639:trends; D016019:Survival Analysis; D013995:Time; D016896:Treatment Outcome
chemical_list: D019039:Platelet Glycoprotein GPIIb-IIIa Complex