INTRACORONARY STENT IMPLANTATION WITHOUT ULTRASOUND GUIDANCE AND WITHREPLACEMENT OF CONVENTIONAL ANTICOAGULATION BY ANTIPLATELET THERAPY -30-DAY CLINICAL OUTCOME OF THE FRENCH-MULTICENTER-REGISTRY

Background Stenting reduces both acute complications of coronary angio plasty and restenosis rates but increases subacute thrombosis rates an d hemorrhagic complications when used with coumadin anticoagulation. M ethods and Results To simplify postcoronary stenting treatment and to reduce these drawbacks, we evaluated the 1-month outcome of a prospect ive registry of 2900 patients in whom successful coronary artery stent ing was performed without coumadin anticoagulation. Patients received 100 mg/d aspirin and 250 mg/d ticlopidine for 1 month. Low-molecular-w eight heparin (LMWH) treatment was progressively reduced in four conse cutive stages, from 1-month treatment to none. Event-free outcome at 1 month was achieved in 2816 patients (97.1%). Major stent-related card iac events were subacute closure in 51 patients (1.8%), including deat h in 12 (0.5%), acute myocardial infarction in 17 (0.6%): and coronary artery bypass graft surgery in 9 (0.3%). Stent thrombosis was more fr equent with balloon size of <3.0 mm (less than or equal to 2.5 mm, 10% ; 3.0 mn, 2.3%; greater than or equal to 3.5 mm, 1.0%; P<.001), bail-o ut situations (6.67% versus 1.38%, P<.001), and patients with unstable angina or acute myocardial infarction (2.2% versus 1.12%, P=.02). Ble eding complications that required transfusion, surgical repair, or bot h occurred in 55 patients (1.9%). Bleeding complications were related to female gender (4.0% versus 1.51%, P<.001), duration of LMWH treatme nt (3.83% in phase II/III versus 0.69% in phase IV/V P<.001), sheath s ize (6F, 0.52%; 7F, 1.04%; greater than or equal to 8F, 4.23%; P<.001) , bail-out situations (4.76% versus 1.67%, P<.01), and saphenous graft stenting (4.38% versus 1.75%, P=.04). Conclusions These results sugge st that poststenting treatment by ticlopidine/aspirin is an effective alternative to coumadin anticoagulation, achieving low rates of subacu te closure and bleeding complications. LMWH treatment does not improve subacute reocclusion rates but increases bleeding complications. Furt hermore; as bleeding complications were independently related to sheat h size, we suggest that stenting with 6F guiding catheters may prevent local complications. Furthermore, the ticlopidine/aspirin combination allows a low-cost stenting strategy without ultrasound assessment of stent deployment and permits short in-hospital stay.