title: In-hospital and mid-term adverse clinical outcomes of a direct stenting strategy versus stenting after pre-dilatation for the treatment of coronary artery lesions.
abstract: BACKGROUND
  Direct stenting without balloon dilatation may reduce procedural costs and duration, and hypothetically, the restenosis rate. This study was designed to compare the in-hospital and long-term outcomes of direct stenting (DS) versus stenting after pre-dilatation (PS) in our routine clinical practice.
  
  
  METHODS
  The 1 603 patients treated with stenting for single coronary lesions were enrolled into a prospective registry. Patients with acute myocardial infarction (MI) within the preceding 48 hours, and those with highly calcified lesions, total occlusions, or a lesion in a saphenous graft were excluded. The baseline, angiographic and procedural data, in-hospital outcomes and follow-up data were recorded in our database and analysed with appropriate statistical methods.
  
  
  RESULTS
  Eight hundred and fifty-seven patients (53.5%) were treated with DS and 746 (46.5%) underwent PS. In the DS group, lesions were shorter in length, larger in diameter and had lower pre-procedural diameter stenosis. Type C and diffuse lesions and drug-eluting stents were found less often (p < 0.001). With univariate analysis, dissection and non- Q-wave MI occurred less frequently in this group (0.2 and 0.6% vs 3.9 and 2.1%, p < 0.001 and p = 0.01, respectively). However, the cumulative major adverse cardiac events (MACE) did not differ significantly (4.9 vs 4.6%, p = 0.79). With multivariate analysis, direct stenting reduced the risk of dissection (OR = 0.07, 95% CI: 0.01-0.33, but neither the cumulative endpoint of MACE (OR = 1.1, 95% CI = 0.58- 2.11, p = 0.7) nor its constructing components were different between the groups.
  
  
  CONCLUSIONS
  Direct stenting in the real world has at least similar long-term outcomes in patients treated with stenting after pre-dilatation, and is associated with lower dissection rates.
authors.affiliation: Department of Interventional Cardiology, Tehran Heart Centre, Medical Sciences, University of Tehran, Iran. mariaraissi@gmail.com
authors.forename: M
authors.initials: M
authors.lastname: Alidoosti
authors.forename: M
authors.initials: M
authors.lastname: Salarifar
authors.forename: S E
authors.initials: SE
authors.lastname: Kassaian
authors.forename: A M
authors.initials: AM
authors.lastname: Zeinali
authors.forename: M S
authors.initials: MS
authors.lastname: Fathollahi
authors.forename: M R
authors.initials: MR
authors.lastname: Dehkordi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors