Acute and nine-month clinical outcomes after "suboptimal" coronary stenting - Results from the STent Anti-thrombotic Regimen Study (STARS) registry

OBJECTIVES This registry collected the 30-day and 9-month clinical outcomes of patients whose coronary stent implantation was suboptimal, and compared them with the cohort of patients with "optimal" stenting in the randomized portion of the STent Anti-thrombotic Regimen Study (STARS) trial. BACKGROUND Although "optimal" stenting combined with an aspirin and ticlopi dine regimen carries a low (0.5%) incidence of subacute stent thrombosis, o nly limited data are available for patients in whom stents are deployed sub optimally. METHODS In the STARS, 312 (15.9%) of 1,965 patients enrolled were excluded from participation in the randomized trial based on a perceived "suboptimal " result of coronary stenting. Of these, 265 patients met prespecified crit eria for suboptimal stenting, and were followed in a parallel registry, whi ch was compared with the randomized STARS optimal stenting cohort. The prim ary end point was a 30-day composite of death, emergent target lesion revas cularization, angiographic thrombosis of the target vessel without revascul arization and nonfatal myocardial infarction (MI)unrelated to direct proced ural complications. RESULTS Registry patients had a similar frequency of the primary end point compared with the overall randomized cohort (3.0% vs. 2.2%), with this end point correlating to use of multiple stents, smaller final lumen diameter a nd absence of ticlopidine from the poststent regimen. Overall 30-day mortal ity (1.1% vs. 0.06%, p = 0.009) and periprocedural non-Q wave MI (8.7% vs. 4.2%, p = 0.003) were more frequent in registry patients, and appeared to b e related to acute procedural complications. Clinical restenosis was signif icantly higher for registry patients (26.8% vs. 16.0%, p = 0.001), relating to greater prevalence of independent predictors such as smaller final lume n diameter and multiple stent use. CONCLUSIONS In the STARS registry, the inability to perform optimal stentin g correlated with smaller final lumen diameter and longer stent length. Wit h ticlopidine-containing regimens, the acute clinical results of "suboptima l" stent deployment are clinically acceptable, although they Ne not quite a s good as those of optimal stenting using similar drug therapy. (J Am Coll Cardiol 1999;34:698-706) (C) 1999 by the American College of Cardiology.