PALMAZ-SCHATZ CORONARY STENT IMPLANTATION WITHOUT INTRAVASCULAR ULTRASOUND AND WITHOUT SUBSEQUENT ANTICOAGULATION - CLINICAL OUTCOME

Objectives. To determine the safety and efficacy of antiplatelet thera py alone in a selected group of patients following coronary stenting. Background. Coronary stent implantation is an effective treatment for abrupt closure, and can also reduce the restenosis rate following perc utaneous transluminal coronary angioplasty. However, anticoagulation t herapy following stent implantation is associated with a significant i ncidence of vascular complications and subacute stent thrombosis. Meth ods. Between February and November 1994 we implanted 62 Palmaz-Schatz stents in 50 patients with an optimal angiographic result following st ent deployment. In these patients, intravascular ultrasound was not us ed, and a regimen of aspirin 100 mg daily indefinitely and ticlopidine 250 mg twice daily for 3 months was started without anticoagulation. Results. Of these 50 patients (10 females : 40 males, mean age 63 +/- 12 years, LVEF 64 +/- 10%), 39 (78%) were stented for a suboptimal ang iographic result post angioplasty, 2 (4%) received stents as a bailout procedure, and 9 (18%) were stented electively. Average hospital stay following stent implantation was 3.7 +/- 3.0 days. After a mean follo w-up period of 140 +/- 70 days, there were no instances of stent occlu sion, death, stroke, need for coronary bypass surgery, Q wave myocardi al infarction or femoral artery pseudoaneurysm. There was 1 case (2%) of significant puncture site hemorrhage. Conclusions. Immediate angiog raphic appearance after stent implantation can be used to define patie nts at low risk of stent thrombosis, who do not require anticoagulatio n and can safely be discharged early from the hospital.