CORONARY STENTING IN UNSTABLE ANGINA - EARLY AND LATE CLINICAL OUTCOMES

OBJECTIVE: To examine the procedural and long term success of coronary stenting in patients presenting with unstable angina and the effect o f warfarin on the clinical outcome of these high risk patients. DESIGN : A nonrandomized, retrospective analysis of patients presenting with unstable angina. SETTING: A tertiary care, Canadian university-affilia ted teaching hospital. PATIENTS: Of 1250 patients who underwent percut aneous transluminal coronary angioplasty between January 1994 and June 1995, 365 underwent coronary stenting. The study population consisted of the 156 patients presenting with unstable angina who underwent cor onary stenting. Patients with Canadian Cardiovascular Society class IV and postinfarction angina were included. INTERVENTIONS: Stent deliver y by standard techniques to the target lesion was successful in all pa tients. At discharge, 88 patients were prescribed warfarin, ticlopidin e and acetylsalicylic acid (ASA); the remaining 68 patients received o nly ticlopidine and ASA. Late clinical outcomes were assessed by telep hone interview. RESULTS: The overall procedural success rate was 96%. One patient died in hospital (0.6%). Other events were abrupt closure (1.9%), myocardial infarction (1.9%) and urgent bypass surgery (1.9%). During follow-up, target vessel reintervention was needed in 19.6% of patients. Early and late clinical outcomes did not differ significant ly between anticoagulated patients and those treated with antiplatelet agents alone, but anticoagulated patients had a significantly longer hospital stay. CONCLUSIONS: Coronary stenting in patients with unstabl e angina was associated with excellent procedural success and favourab le late clinical outcomes. Warfarin added no apparent additional clini cal benefit to antiplatelet agents in this high risk population.