Baseline clinical and angiographic variables associated with long-term outcome after successful intracoronary stent implantation

Although randomized studies have demonstrated improved outcomes with stents over balloon angioplasty in straightforward coronary narrowings in low-ris k patients, this advantage is less clear for complex lesions and high-risk patients. This study was designed to identify clinical and angiographic var iables that are associated with long-term outcome after stent implantation. We identified 1,709 patients undergoing successful stent placement without in-hospital major adverse events. We analyzed clinical, lesional, and proc edural variables to determine their correlation with outcome. Mean duration of follow-up was 1.6 +/- 1.4 years. Cox proportional-hazards models and st epwise methods were used ta assess which covariates were potentially relate d to each end point. The occurrence of death/myocardial infarction (MI) was associated with any history of congestive heart failure (relative risk [RR ] 3.3, 95% confidence interval [CI] 2.3 to 4.7, p < 0.0001), procedure with in 24 hours of MI (RR 2.3, CI 1.3 to 4.1, p = 0.0048), vein graft intervent ion (RR 1.8, CI 1.3 to 2.6, p = 0.0007), and prior MI (RR 1.8, CI 1.2 to 2. 6, p = 0.004). Repeat revascularization was associated with multivessel ste nt placement (RR 1.8, CI 1.2 to 2.8, p = 0.006) and stent for abrupt closur e (RR 1.7, CF 1.1 to 2.7, p = 0.03), but was less frequent with de novo les ions and right coronary artery lesions (RR 0.6, CI 0.5 to 0.8, p = 0.0007, and RR 0.8, CI 0.6 to 1.0, P = 0.05, respectively). The cumulative end poin t of death/MI/repeat revascularization was associated with congestive heart failure (88 1.7, CI 1.3 to 2.2, p < 0.0001), multivessel stent placement ( RR 1.6, CI 1.1 to 2.3, p = 0.03), warfarin therapy (RR 1.4, Cl 1.2 to 1.8, p = 0.001), and procedure within 24 hours of MI (RR 1.5, CI 1.1 to 2.1, p = 0.02), but was less frequent with complete revascularization and right cor onary:artery intervention (RR 0.8, CI 0.7 to 0.99, p 0.04, and BR 0.7, CI 0 .6 to 0.9, p = 0.009, respectively). Thus, this study demonstrates that the re are readily identifiable characteristics in patients treated successfull y with stents that are associated with long-term outcome. (C) 1999 by Excer pta Medica, Inc.