Staged versus one-step approach for multivessel percutaneous coronary interventions.
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.
Nikolsky
Eugenia
E
Division of Invasive Cardiology, Rambam Medical Center and the Technion-Israel Institute of Technology, Haifa, Israel.
Halabi
Majdi
M
Roguin
Ariel
A
Zdorovyak
Alexander
A
Gruberg
Luis
L
Hir
Jamal
J
Grenadier
Ehud
E
Boulos
Monther
M
Markiewicz
Walter
W
Linn
Shai
S
Beyar
Rafael
R
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
D000925:Anticoagulants; D005343:Fibrinolytic Agents