PROCEDURAL RESULTS AND LATE CLINICAL OUTCOMES AFTER PLACEMENT OF 3 ORMORE STENTS IN SINGLE CORONARY LESIONS

Background-Previous reports have suggested higher procedural and long- term complications among patients treated with multiple stents for dif fuse lesions and/or long dissections. Methods and Results-To evaluate procedural success, major complications, and clinical outcomes (greate r than or equal to 1 year) in a consecutive series of patients treated with multiple (greater than or equal to 3) contiguous stents in singl e lesions, we evaluated in-hospital and long-term (1-year) clinical ou tcomes in 117 consecutive patients treated with greater than or equal to 3 coronary stents compared with a concurrent series of patients tre ated with 1 or 2 stents (n=1673) between January 1, 1994, and December 31, 1995. Multiple stents were implanted more often in larger vessels , in the right coronary artery or saphenous vein,grafts, and for unfav orable lesion characteristics, including long (>20 mm), calcified, ulc erated, thrombotic, and/or flow-obstructing lesions. Overall procedura l success was obtained in 97.4% of patients and was similar whether 1 or 2 versus greater than or equal to 3 stents were used. Non-Q-wave MI (CK-MB greater than or equal to 5 times normal) was more frequent aft er greater than or equal to 3 stents (22.8% versus 13.4%, P=.005). Tar get lesion revascularization (TLR) was 14.6% for 1 or 2 stents and 13. 3% for greater than or equal to 3 stents (P=.70). There was no differe nce in death (2.2% versus 0.9%, P=.34) or Q-wave MI (1.4% versus 0.9%, P=.64) between the two groups (1 or 2 stents versus greater than or e qual to 3 stents, respectively), and overall cardiac event-free surviv al was similar during follow-up (P=.70). Conclusions-Patients treated with multiple (greater than or equal to 3) contiguous stents compared with 1 or 2 stents have (1) similar in-hospital procedural success and major complications despite having more unfavorable lesion characteri stics, (2) a higher rate of procedural non-Q-wave MI, and (3) similar TLR and overall major cardiac event rates during 1 year of follow-up.