title: Staged versus one-step approach for multivessel percutaneous coronary interventions.
abstract: BACKGROUND
  Percutaneous coronary interventions (PCIs) in patients with multivessel coronary artery disease (CAD) may be staged or performed in a single session. No data exist about the relative safety and efficacy of these 2 strategies. Our aim was to compare short-term and long-term outcomes of patients with multivessel CAD who underwent PCI in 1 versus 2 sessions.
  
  
  RESULTS
  The study included 264 consecutive patients who underwent treatment in our center during 1997 and 1998. PCI was conducted in a single session in 129 patients and was staged in 135 patients. The mean interval between the sessions in the staged group was 45.6 +/- 22.3 days. The rates of major adverse cardiac events (MACEs) during in-hospital stay did not differ significantly between the staged (combined for both stages) and nonstaged groups (2.2% vs 4.6%; P =.28). A trend for lower event rates at 30-day (2.9% vs 6.9%; P =.13) and 1-year follow-up (26.1 vs 35.9; P =.08) favored the staged arm. Diameter stenosis > or =50% was found in 17% of patients in the staged group in the second session and was successfully retreated in most of them. No MACE occurred between the sessions. Multivariate analysis identified staging of the procedure as a single independent predictor of MACE at 1-year follow-up (P =.05).
  
  
  CONCLUSIONS
  Our results suggest that a practical staging strategy within 4 to 8 weeks is safe and allows for identification and treatment of potential excessive proliferative response in the previously intervened lesions during the second procedure.
authors.affiliation: Division of Invasive Cardiology, Rambam Medical Center and the Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Nikolsky
authors.forename: Majdi
authors.initials: M
authors.lastname: Halabi
authors.forename: Ariel
authors.initials: A
authors.lastname: Roguin
authors.forename: Alexander
authors.initials: A
authors.lastname: Zdorovyak
authors.forename: Luis
authors.initials: L
authors.lastname: Gruberg
authors.forename: Jamal
authors.initials: J
authors.lastname: Hir
authors.forename: Ehud
authors.initials: E
authors.lastname: Grenadier
authors.forename: Monther
authors.initials: M
authors.lastname: Boulos
authors.forename: Walter
authors.initials: W
authors.lastname: Markiewicz
authors.forename: Shai
authors.initials: S
authors.lastname: Linn
authors.forename: Rafael
authors.initials: R
authors.lastname: Beyar
mesh_terms: D000787:Angina Pectoris / Q000150:complications / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods*; D000925:Anticoagulants / Q000627:therapeutic use; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000473:pathology / Q000628:therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000628:therapy; D013223:Statistics as Topic; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents