Pharmacological stent deployment in the left anterior descending artery: late event indicators.
BACKGROUND
The efficacy of pharmacological stents in decreasing the incidence of cardiac events is not homogeneous for all lesions or patient subgroups.


OBJECTIVE
1) To evaluate the late clinical evolution of patients submitted to pharmacological stent implantation in atherosclerotic lesions of the left anterior descending artery; 2) to identify, among the clinical, angiographic and intravascular ultrasonographic characteristics, the ones predictive of cardiac event risk.


METHODS
From May 2002 to August 2005, 205 patients were treated with 236 pharmacological stent implants, guided by the intravascular US (IVUS).


RESULTS
After a mean follow-up period of 711 days, the rate of stent thrombosis was 0.48%, the same observed for acute myocardial infarction or revascularization surgery. The revascularization rate of the treated lesion was 7.31% and the general event rate was 10.24%. The event indicators, according to the multivariate analysis were the implant of more than one stent in the same artery, concentric lesions and the minimal intra-stent area measured by IVUS < 3.88 mm(2).


CONCLUSIONS
Based on the data obtained, we conclude that the revascularization of the left anterior descending artery with pharmacological stent implant, chosen and optimized by IVUS, presents a low incidence of late events. The implant of two pharmacological stents for the treatment of long lesions was the main independent factor for the occurrence of late events. The final luminal area > 3.88 mm(2) obtained in the small reference-diameter segments is an independent indicator of event-free evolution.
Santos
Marcelo de Freitas
Mde F
Hospital Cardiológico Costantini, São Paulo, SP, Brazil. mfsantos@cardiol.br
Tarbine
Sergio Gustavo
SG
Costantini
Costantino Ortiz
CO
Oliveira
Maria do Rocio Peixoto
Mdo R
Bubna
Marcos Henrique
MH
Guarita-Souza
Luiz Cesar
LC
Braga
Chiu Yun Yu
CY
Stella
Francisco de Paula
Fde P
Costantini
Costantino Roberto
CR
Rivetti
Luiz Antonio
LA
D000328:Adult; D000368:Aged; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000601:surgery*; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D019919:Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D012307:Risk Factors; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology