COMPARISON OF CLINICAL OUTCOME AFTER ELECTIVE AND BAIL OUT CORONARY STENT INSERTION

Background: Coronary stents may be used electively during percutaneous transluminal coronary angioplasty (PTCA) or as a ''bail-out'' device to treat abrupt or threatened vessel closure following PTCA. Objective : To compare the clinical outcome of elective and ''bail-out'' coronar y stent insertion. Design: A retrospective analysis of all patients re ceiving coronary stents. Setting: Tertiary referral center performing over 400 PTCA procedures a year. Patients: Fifty-six patients (42 male ), mean age 57 (range = 32 to 78) years received 67 Palmaz-Schatz coro nary stents. Forty-nine stents were deployed as ''bail-out'' in 41 pat ients (abrupt vessel closure in 15 and threatened vessel closure in 26 ) and 18 stents were deployed electively in 15 patients. Main Outcome Measures: Myocardial infarction, repeat angiography, coronary artery b ypass graft surgery and death. Results: Stents were successfully deplo yed in 56/62 (90.3%) patients. In-hospital events were significantly m ore common in the ''bail-out'' group compared to the elective group. T he in-hospital events, comparing the ''bail-out'' group versus the ele ctive group, were as follows: Death 2/41 (4.9%) vs 0/15 (0%), coronary artery bypass graft surgery (CABG) 8/41 (19.5%) vs 0/15 (0%), stent t hrombosis 3/41 (7.3%) vs 0/15 (0%), and myocardial infarction 6/41 (14 .6%) vs 1/15 (6.7%) respectively. After discharge no patient died or h ad CABG. One patient in the ''bail-out'' group had a myocardial infarc t (late stent thrombosis). Two patients from each group had repeat ang iography because of recurrent angina in the 6 month follow up period. Conclusion: ''Bail-out'' stenting has an increased incidence of in-hos pital complications compared to elective procedures. If these short-te rm problems can be overcome however, the clinical events in the first 6 months after leaving hospital are low and similar to patients under- going elective procedures.