FREQUENCY OF ADVERSE CLINICAL EVENTS IN THE 12 MONTHS FOLLOWING SUCCESSFUL INTRACORONARY STENT PLACEMENT IN PATIENTS TREATED WITH ASPIRIN AND TICLOPIDINE (WITHOUT WARFARIN)

Little is known about the frequency of adverse events in the year foll owing stent placement in patients treated with aspirin and ticlopidine , without warfarin. We analyzed the first such 234 consecutive patient s treated at our hospital between October 1994 and December 1995. Thei r mean age was 62 +/- 12 years; 40% had had a prior myocardial infarct ion, 22% had undergone coronary artery bypass surgery, and 65% had mul tivessel disease. The indication for stent placement was dissection or abrupt closure in 24% of patients and suboptimal balloon angioplasty results in 14%; placement was elective in 62% of patients. Three hundr ed ferry-five coronary segments were treated in the 234 patients; 305 stents (1.3 stents/patient) were placed. Palmaz-Schatz coronary stents (75%), Gianturco-Roubin stents (21%), and Johnson & Johnson biliary s tents (4%) were used. Mean nominal stent size was 3.4 +/- 0.4 mm. High -pressure inflations (greater than or equal to 14 atm, mean 17 +/- 2) were performed in all patients. The mean residual stenosis was 3 +/- 5 % by visual estimate. Intravascular ultrasound was utilized to facilit ate stent placement in 53% of patients. Mean follow-up was 1.6 +/- 0.5 years. There were no deaths, Q-wave myocardial infarctions, coronary artery bypass operations, or repeat angioplasty procedures required du ring the remainder of the hospitalization or in 30 days after stent pl acement; stent thrombosis did not occur. Kaplan-Meier analysis of adve rse events in the 6 months following the procedure revealed a mortalit y rate of 0.9%; the rare of myocardial infarction (Q-wave or non-Q-wav e) was 1.3%. Bypass surgery was performed in 0.9% and angioplasty for in-scent restenosis was performed in 9.5% of patients. Any 1 of these events occurred in 11.7% of patients in the 6 months after the procedu re. The corresponding event rates at 1 year were 1.3%, 2.2%, 3.5%, and 12.2%, respectively; any 1 of these events occurred in 16.5% of patie nts. In patients receiving intracoronary stents of varying designs fol lowed by high-pressure postdeployment inflations in whom an excellent visual angiographic result is achieved, antithrombotic therapy with as pirin and ticlopidine is associated with a very low frequency of adver se cardiovascular events in the 12 months following the procedure rega rdless of the indication for stent placement. (C) 1998 by Excerpta Med ica, Inc.