ACUTE AND LONG-TERM OUTCOME AFTER PALMAZ-SCHATZ-STENTING - ANALYSIS FROM THE NEW-APPROACHES-TO-CORONARY-INTERVENTION (NACI) REGISTRY

The randomized Stent Restenosis Study (STRESS) and Belgium Netherlands Stent (Benestent) trials established that elective use of Palmaz-Scha tz stents (PSSs) in native coronary arteries with de novo lesions is a ssociated with increased procedural success and reduced restenosis. Ho wever there are other clinical indications for which stents are common ly used (unplanned use, vein grafts, restenosis lesions) that are not addressed in these studies. From 1990-1992, 688 lesions in 628 patient s were treated with PSSs in the New Approaches to Coronary Interventio n (NACI) registry. Angiographic core laboratory readings were availabl e for 543 patients (595 lesions, of which 106 were stented for unplann ed indications, 239 were in saphenous vein bypass grafts, and 296 were previously treated). The cohort of patients in whom stents were place d for unplanned indications had more women, current smokers, and had a higher incidence of recent myocardial infarction (MI). Patients who u nderwent stenting of saphenous vein grafts were older, had a higher in cidence of diabetes mellitus, unstable angina, prior MI, and congestiv e heart failure. Lesion success was similar in all cohorts (98%), but procedural success was significantly higher for planned stenting (96% vs 87%; p <0.01). Predictors of adverse events in-hospital were presen ce of a significant left main stenosis and stenting for unplanned indi cation. The incidence of target lesion revascularization by 30 days wa s significantly higher for patients undergoing unplanned stenting due to a higher risk for stent thrombosis. Recent MI, stenting in native l esion, and small postprocedural minimum lumen diameter independently p redicted target lesion revascularization at 30 days. Independent predi ctors of death, Q-wave myocardial infarction, or target lesion revascu larization at 1 year included severe concomitant disease, high risk fo r surgery, left main disease, stenting in the left main coronary arter y, and low postprocedure minimum lumen diameter. (C) 1997 by Excerpta Medico, Inc.