title: Unrestricted availability of intracoronary stents is associated with decreased abrupt vascular closure rates and improved early clinical outcomes.
abstract: The purpose of this study was to determine whether the unrestricted availability of intracoronary stents is affecting abrupt vascular closure rates and early clinical outcomes. Intracoronary stents have improved procedural outcome despite their application in more complex lesions, but the impact of unrestricted availability of stents on abrupt closure and early clinical outcomes is unknown. Two cohorts were identified retrospectively from a coronary intervention registry: patients treated between 1988 and 1992 (n = 3,617) when stents were not generally available, and patients treated between 1994 and 1997 (n = 4,518) when stents were freely available. The late cohort patients consisted of more females; it also had greater comorbidity and more complex presentation. However, there was a significant reduction in the abrupt closure rates between the two time periods (7% vs. 4%, P < 0.0001). After adjusting for female gender, thrombus, and lesion angulation, the late cohort remained significantly associated with decreased odds of abrupt closure (odds ratio [OR] = 0.62, 95% upper and lower confidence intervals [CI] = 0.52-0.75, P = 0.0001). The late cohort also had decreased in-hospital mortality (OR = 0.91, CI = 0.86-0.95, P = 0.0002) and major adverse clinical event (OR = 0.93, CI = 0.91-0.96, P = 0.0001). Unrestricted availability of intracoronary stents is associated with reduced abrupt closure rates and improved early clinical outcomes among patients undergoing coronary intervention despite treatment of high-risk patients.
authors.affiliation: Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
authors.forename: W Warren
authors.initials: WW
authors.lastname: Suh
authors.forename: Diane E
authors.initials: DE
authors.lastname: Grill
authors.forename: Charanjit S
authors.initials: CS
authors.lastname: Rihal
authors.forename: Malcolm R
authors.initials: MR
authors.lastname: Bell
authors.forename: David R
authors.initials: DR
authors.lastname: Holmes
authors.forename: Kirk N
authors.initials: KN
authors.lastname: Garratt
mesh_terms: D000208:Acute Disease; D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects* / Q000379:methods*; D001157:Arterial Occlusive Diseases / Q000209:etiology* / Q000517:prevention & control*; D015331:Cohort Studies; D023903:Coronary Restenosis / Q000209:etiology* / Q000517:prevention & control*; D005260:Female; D006083:Graft Occlusion, Vascular; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome