Improved long-term survival associated with stent deployment during percutaneous coronary interventions: results from a registry of 3399 patients.
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.
Muhlestein
Joseph B
JB
Division of Cardiology, Department of Cardiovascular Medicine, LDS Hospital, Salt Lake City, Utah 84143, USA. ldbmuhle@ihc.com
Anderson
Jeffrey L
JL
Cui
ChangZong
C
Lan
YanPing
Y
Bair
Tami L
TL
Bunch
T Jared
TJ
Pearson
Robert R
RR
Sorensen
Sherman G
SG
Renlund
Dale G
DG
Zhang
Li
L
Horne
Benjamin D
BD
Vincent
G Michael
GM
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