title: Improved long-term survival associated with stent deployment during percutaneous coronary interventions: results from a registry of 3399 patients.
abstract: BACKGROUND
  The use of stents in percutaneous coronary intervention (PCI) improves procedural success and reduces restenosis. However, few studies have had a sufficient sample size or adequate follow-up to determine whether this advantage results in a positive effect on mortality.
  
  
  METHODS
  A total of 3399 patients undergoing PCI (stented [with dual antiplatelet therapy]: n = 2456, nonstented [balloon PCI or rotational atherectomy]: n = 942) at a single institution from 1994 to 2001 were followed up prospectively (43 +/- 22 and 54 +/- 25 months, respectively) for acute and long-term clinical outcomes.
  
  
  RESULTS
  Angiographic success (< 50% residual stenosis) (99.7% vs 97.7%, P < .001) and acute gain (3.02 +/- 0.55 vs 2.08 +/- 0.62 mm, P < .001) were both greater for stented lesions. Likewise, procedural complications of death (0.04% vs 0.4%, P = .02) and dissection (4.9% vs 8.0%, P = .001) were lower in the stent group, as were rates of 6-month clinical restenosis (10.3% vs 16.3%, P < .001). Eight-year mortality (12.0% vs 18.2%, hazard ratio = 0.78, P = .009) was lower among the stent group, as was long-term major adverse cardiac events (36.2% vs 50.6%, P < .001), but no difference in long-term myocardial infarction was found (6.5% vs 7.6%, P = .28). In multivariable Cox regression, stent use (hazard ratio = 0.76, 95% CI [0.58-0.99], P = .04) remained associated with significantly reduced mortality.
  
  
  CONCLUSIONS
  This large prospective study demonstrates that, in addition to a general improvement in procedural success and a reduced need for repeat revascularization, the use of stents with dual antiplatelet therapy was associated with a significant reduction in long-term mortality. Consideration should be given for the use of stents whenever feasible during PCI.
authors.affiliation: Division of Cardiology, Department of Cardiovascular Medicine, LDS Hospital, Salt Lake City, Utah 84143, USA. ldbmuhle@ihc.com
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Muhlestein
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Anderson
authors.forename: ChangZong
authors.initials: C
authors.lastname: Cui
authors.forename: YanPing
authors.initials: Y
authors.lastname: Lan
authors.forename: Tami L
authors.initials: TL
authors.lastname: Bair
authors.forename: T Jared
authors.initials: TJ
authors.lastname: Bunch
authors.forename: Robert R
authors.initials: RR
authors.lastname: Pearson
authors.forename: Sherman G
authors.initials: SG
authors.lastname: Sorensen
authors.forename: Dale G
authors.initials: DG
authors.lastname: Renlund
authors.forename: Li
authors.initials: L
authors.lastname: Zhang
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Horne
authors.forename: G Michael
authors.initials: GM
authors.lastname: Vincent
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D023921:Coronary Stenosis / Q000401:mortality* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012042:Registries; D015607:Stents; D015996:Survival Rate; D013997:Time Factors