Early results of direct coronary stenting in consecutive patients when multivessel, complex, long lesions, and small vessels are included.
BACKGROUND
Direct coronary stenting is the dominant technique for coronary stent implantation, but previous randomized studies have strongly selected lesions to treat. To evaluate whether the results can be generalized to routine clinical practice, all consecutive patients with direct stenting in 15 hospitals were entered into a prospective registry. Single vessels and simple lesions, but also multivessel, complex and long lesions, and small vessels size (< or =2.5 mm) were included. Immediately results as well as clinical events within 30 days after the procedure were evaluated.


METHODS
Between April and November 2002, direct coronary stenting was performed in 452 consecutive patients (559 lesions) at 15 sites. Stents edge-protected by "sleeves" (SOX technology, NIR Stent, Boston Scientific) or with short transitional edge protection (STEP technology, Multilink Stents, Guidant) were selected to minimize vessel injury outside the stent edges during balloon inflation/deployment.


RESULTS
Stents were successfully implanted in 96% of lesions. Lesions were multivessel in 27%, type B2-C in 40%, very angulated in 28%, calcified in 18%, and longer than 20 mm in 10% of patients. Vessels were smaller than < or =2.5 mm in 27% of patients. Direct coronary stenting was unsuccessful in 25 lesions (24 patients) characterized by more unstable angina (p=0.07), more treated lesions (p<0.01), and more distal locations (p=0.001). Dissection occurred in 6% of patients, and one stent embolised. The 30-day follow-up period included 1 death (due to subacute occlusion), 11 (2.4%) acute myocardial infarctions (8 non-Q wave), and one stroke (following carotid surgery).


CONCLUSIONS
Direct coronary stenting yielded excellent results at 30 days although some expanded indications will be included.
Fournier
Juan A
JA
Virgen del Rocío University Hospital, Seville, Spain. fournier@supercable.es
Hernández
José M
JM
Ramírez
José A
JA
Valdés
Mariano
M
Bethencourt
Armando
A
Insa
Luis
L
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D019917:Blood Vessel Prosthesis Implantation; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000601:surgery; D017023:Coronary Angiography; D003327:Coronary Disease / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011446:Prospective Studies; D012042:Registries / Q000706:statistics & numerical data; D015607:Stents; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome