Clinical outcome after multivessel coronary stent implantation

Background Percutaneous transluminal coronary angioplasty (PTCA) has been s hown to be an effective therapy for multivessel coronary artery disease, al though more frequent acute complications and an increased need to repeat re vascularization than with single-vessel PTCA continue to be limitations. In tracoronary stent placement has been shown to reduce the rate of acute comp lications and the need for subsequent revascularization, We sought to evalu ate the outcome among patients undergoing successful multivessel coronary i ntervention with stents. Methods The participants were 175 patients without coronary artery bypass g rafts who underwent multivessel coronary revascularization in which stent p lacement was attempted in all treated segments from January 1992 through Ma rch 1998 at our institution. Clinical and angiographic characteristics and outcomes were analyzed. Results stent placement was attempted for 428 coronary lesions. The angiogr aphic success rate was 100%. Modified American College of Cardiology-Americ an Heart Association type B2 and C lesions accounted for 74.5% of the lesio ns. Three patients (1.7%) died in the hospital. No patient had Q-wave myoca rdial infarction or needed coronary artery bypass grafting. Procedural succ ess was achieved for 172 patients (98.3%). The Kaplan-Meier probability of freedom from death or myocardial infarction at 12 months was 96.6%, of any revascularization was 81.7%, and of death, myocardial infarction, and any r evascularization combined was 79.8%, The use of long-acting nitrates at 12 months was reduced (34.3% versus 19.1%, P = .07). Conclusions Multivessel coronary stent placement is associated with an exce llent procedural success rate despite a high rate of adverse lesion charact eristics and a high event-free survival rate during the follow-up period. T he likelihood that revascularization will not have to be repeated during th e first follow-up year is significantly better than that for historic contr ols of multivessel PTCA.