Coronary stenting for unstable angina: predictors of 30-day and long-term clinical outcome
| Autor: | Antonio Marzocchi, Cinzia Marrozzini, Giancarlo Piovaccari, Angelo Branzi, Lucia Marinucci, Francesco Saia, Maria Letizia Bacchi Reggiani, Paolo Ortolani, Bruno Magnani, Tullio Palmerini, Giampiero Nobile |
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| Rok vydání: | 1999 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.drug_class medicine.medical_treatment Revascularization Coronary Angiography Coronary artery disease Angioplasty Internal medicine medicine Humans cardiovascular diseases Myocardial infarction Angina Unstable Angioplasty Balloon Coronary Aged Retrospective Studies Aged 80 and over Unstable angina business.industry Cardiogenic shock Anticoagulant Stent General Medicine Middle Aged medicine.disease Survival Rate Treatment Outcome Cardiology Female Stents business Cardiology and Cardiovascular Medicine Follow-Up Studies |
| Zdroj: | Scopus-Elsevier |
| ISSN: | 0954-6928 |
| Popis: | BACKGROUND Unstable angina is usually caused by acute thrombosis superimposed on a fissured plaque. Coronary artery stenting has been shown to improve short- and long-term results of coronary angioplasty in mainly stable patients with one-vessel disease, but it is uncertain whether its use in an unstable clinical setting can be safe and useful. This study sought to evaluate the results of coronary stenting in unstable angina and to determine patient, lesion and procedure-related predictors of 30-day and long-term ischemic events. METHODS We studied 266 consecutive patients (mean age 62 +/- 9 years) with unstable angina who underwent coronary artery stenting. The procedure was performed electively in 24%, in bailout situations in 11% and for a suboptimal result of conventional angioplasty in 65%. After stent implantation, patients were treated with anticoagulation (61) on combined antiplatelet therapy (200). Multivariate logistic regression analyses were performed to determine 30-day and long-term predictive factors of ischemic complications. RESULTS Procedural success was obtained in 261 patients (98.1%). During the first 30 days after stenting, one patient died from cardiogenic shock (0.3%) and six (22%) suffered a non-fatal Q-wave myocardial infarction. Patients with combined antiplatelet therapy had a significantly lower stent thrombosis rate (1.5% versus 11.4%, P = 0.002) than those treated with anticoagulant regimen. At long-term follow-up (17.7 +/- 9.4 months) cardiac mortality myocardial infarction and target-vessel revascularization rates were 0.4%, 1.5% and 9.3%, respectively. In multivessel and diabetic patients, a worse long-term event-free survival was observed. Logistic multivariate analysis revealed bailout stenting, anticoagulant therapy, implantation of stents longer than 15 mm as predictors of 30-day ischemic events. In addition, multivessel coronary artery disease and stent application with balloon size of less than 3 mm were predictive of long-term ischemic events. CONCLUSIONS This study demonstrates that, either electively or after failure of conventional angioplasty, coronary stenting represents an effective therapy for patients with unstable angina. In the same clinical setting, combined antiplatelet therapy is associated with a lower 30-day stent thrombosis rate than anticoagulant therapy. Bailout stenting, anticoagulant therapy, implantation of stents longer than 15 mm were shown to be predictors of 30-day ischemic events, whereas multivessel coronary artery disease and stent application with small balloon size were predictive of long-term ischemic events. |
| Databáze: | OpenAIRE |
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