'Primary intention' intracoronary stenting guided by angiography alone: A safe approach

OBJECTIVE: To examine the outcome of intracoronary stent placement by 'prim ary intention', guided by angiography alone, and without the use of postpro cedural anticoagulation. DESIGN: Prospective, observational study. SETTING: Canadian university teaching hospital. PATIENTS: Patients (n=559) undergoing urgent or elective percutaneous revas cularization procedures (n=616) in whom a preprocedural decision to employ coronary stent placement was made. Emergency and bailout stent procedures w ere excluded. INTERVENTION: Stents were delivered at high pressure (1616 to 1818 kPa) on balloons matched to the proximal reference segment diameter. Adequacy of st ent deployment was judged by angiographic criteria alone. Postprocedural me dication included acetylsalicylic acid and ticlopidine. quantitative corona ry angiographic analysis was independently performed. Acute procedural outc omes were prospectively collected. Patients were followed for one year. RESULTS: All but one patient had a successful angiographic result. Periproc edural death (0.3%), a wave myocardial infarction (MI) (0%), non-Q MI (1.6% ) and stent thrombosis (0.6%) were uncommon events. At one year, 96% of pat ients were alive and free of MI, while 12% of patients required repeat targ et lesion revascularization. CONCLUSION: A primary intention strategy of intracoronary stenting, guided by angiography alone, is a safe and effective approach to percutaneous coro nary revascularization.