INDICATIONS FOR CORONARY STENT IMPLANTATION - COMPARISON OF ACUTE CARDIAC AND VASCULAR COMPLICATIONS IN RELATION TO INDICATION

Background and objective: Coronary stents are used nowadays not only f or the reduction of restenosis and for treating acute vessel occlusion s after PTCA but also after acute myocardial infarction. This study wa s undertaken to determine whether widening the indications has affecte d the incidence of acute complications and to compare acute cardiac an d vascular complications. Patients and methods: The data on 197 consec utive patients (155 men, 42 women; mean age 62 +/- 9 [37-85] years) wi th coronary stents were analysed retrospectively, divided into 5 group s depending on the indications for the stent implantation: 1) acute or threatened vessel occlusion after elective PTCA (>> bail-out <<); 2) acute myocardial infarction (AMI); 3) unstable angina with threatened vessel occlusion; 4) suboptimal primary results (angiographically asse ssed) after PTCA; 5) elective stent implantation to prevent restenosis . Acute or subacute stent thrombosis, side-branch occlusion, intra- an d transmural infarction, death and emergency aortocoronary bypass oper ation were classified as acute cardiac complications. Haemorrhage in t he inguinal region requiring blood transfusion, false aneurysm and ope rative vascular reconstruction were classified as vascular complicatio ns. Results: An intended stent implantation was impossible in 18 patie nts (primary success rate 91%). Independent of indication an acute or chronic stent stenosis occurred in three (1.6%) and seven (3.9%) patie nts, respectively. Side-branch occlusion was observed in 12 patients ( 6.7%), transmural infarction in nine (5.6%). No emergency bypass opera tion had to be performed. Comparing the different indication groups th ere was a significantly increased rate of >> non-Q << infarctions in p atients with unstable angina pectoris (P < 0.014). Among acute vascula r complications (10 [5%] inguinal haemorrhages requiring transfusion a nd 5 [2.5%] operative vascular reconstructions), false aneurysm was si gnificantly more common in patients with AMI (P < 0.014). Comparing em ergency and elective stent implantations, side-branch occlusions were significantly more common in the former (12% vs. 0%; P < 0.08), as wer e also >> non-Q << infarcts (10% vs. O%; P < 0.002). Conclusion: Coron ary stent implantation for these indications, including AMI, can be ta ken as firmly established. Stent thrombosis was not significantly incr eased after >> bail out <<. Implantation in an acute ischaemic episode led to a significantly higher incidence of side-branch occlusion and >> non-Q << infarction.