STANDBY VERSUS STENT-BY DURING PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

To evaluate the impact of a more liberal use of endoluminal stenting o n the incidence of emergency coronary artery bypass grafting, we analy zed our attitude toward abrupt or threatened closure after percutaneou s transluminal coronary angioplasty from 1986 through 1993. In 3083 pr ocedures performed, 204 (6.6%) patients had abrupt or threatened closu re. The incidence of closure or threatened closure remained stable dur ing the 8 years, ranging between 5% (1986) and 8% (1987) (p = 0.89). E ndoluminal stent implantation was attempted in 92 patients and success fully achieved in 90 (98%), and emergency bypass grafting had to be pe rformed in 41 patients. The proportion without adverse end point (deat h or myocardial infarction) was higher in the patients treated by endo luminal stenting than in patients treated with bypass grafting (71/90 (79%) patients vs 17/41 (40%) patients, respectively; p < 0.0001). The use of bailout stenting gradually increased from 0.4% (1986) to 5.6% (1993) of all procedures (p=0.0001), whereas the incidence of emergenc y bypass grafting decreased from 2.7% (1986) to 0.7% (1993) (p = 0.04) . Meanwhile, the incidence of myocardial infarction remained stable be tween 5.6% (1988) and 1.8% (1992) (p= 0.1), and death rates decreased from 1.4% (1988) to 0.2% (1993) (p = 0.05). It is concluded that ''ste ntby'' is a highly effective therapeutic approach (79% in the present study) toward closure after coronary angioplasty and that, although su rgical ''stand-by'' is certainly mandatory for selected cases, routine stand-by is questionable.