Long term outcome after coronary stent implantation: a 10 year single centre experience of 1000 patients

Objective-To describe the long term clinical outcome (up to 11 years) after coronary stenting. Design-A single centre observational study encompassing 1000 consecutive pa tients with a first stent implantation (1560 stents) between 1986 and 1996, who were followed for at least one year with a median follow up of 29 mont hs (range 12-132 months). Results-Up to July 1997 the cumulative incidence of the major adverse cardi ac events (MACE) of death, non-fatal acute myocardial infarction, coronary artery bypass grafting, and repeat percutaneous transluminal coronary angio plasty was 8.2%, 12.8%, 13.1%, and 22.4%, respectively. Survival at one, th ree, and five years was 95%, 91%, and 86%, respectively. Comparison of MACE incidence during the ((anticoagulant era)) and the ((ticlopidine era)) rev ealed significantly improved event free survival with ticlopidine (27% v 13 %; p < 0.005). Multivariable analyses showed that ejection fraction < 50% ( relative risk (RR) 4.1), multivessel disease (RR 3.0), diabetes (RR 2.9), i mplantation in saphenous vein graft (RR 2.1), indication for unstable angin a (RR 1.9), and female sex (RR 1.7) were independent predictors of increase d mortality after stenting. Independent predictors of any IMAGE were multiv essel stenting (RR 2.0), implantation in saphenous bypass graft (RR 1.6), d iabetes (RR 1.5), anticoagulant treatment (versus ticlopidine and aspirin) (RR 1.5), bailout stenting (RR 1.5), multivessel disease (RR 1.4), and mult iple stent implantation (RR 1.5). Conclusions-Long term survival and infarct free survival was good, particul arly in non-diabetic men with single vessel disease and good ventricular fu nction, who had a single stent implanted in a native coronary artery. A dra matic improvement was observed in event free survival, both early and late, with the replacement of anticoagulation by ticlopidine. This, of course, c annot be separated from improved stent implantation techniques between 1986 and 1995. Ultimately, almost 40% of the patients experienced an adverse ca rdiac event (mainly repeat intervention) in the long term. New advances in restenosis treatments and in secondary prevention must be directed at this aspect of patient management after stenting.