Immediate and late outcomes after direct stent implantation without balloon predilation

OBJECTIVES The aim of our study was to compare the in-hospital and long-ter m clinical outcomes of direct coronary stenting with balloon predilation fo llowed by stent placement. BACKGROUND With improvement in stent designs, the practice of direct stenti ng without balloon predilation has become more widespread. METHODS We analyzed the Mayo Clinic Coronary Intervention data base between January 1, 1995 and March 5, 1999 and identified 777 patients who were tre ated with direct stenting (DS) and 3,176 patients treated with balloon angi oplasty plus stenting (BA+S). RESULTS The procedural success rates between the DS and BA+S groups were no t significantly different (96.3% vs. 96.4%). The ability to deliver the ste nt in a subgroup of patients who had DS was 95%, with 5% requiring crossove r to predilation. Multivariate analysis showed no significant differences w ith respect to in-hospital death (odds ratio [OR] 0.9, 95% confidence inter val [CI] 0.5 to 1.8), in-hospital myocardial infarction (OR 0.9, 95% CI 0.6 to 1.2) or revascularization (OR 0.7, 95% CI 0.4 to 1.5) in the DS compare d with the BA+S group. Long-term outcomes were not significantly different between the DS and BA+S groups. The procedural duration was significantly s horter in the DS group, and there was a decreased utilization of contrast a gent, balloons and wires. CONCLUSIONS The in-hospital and long-term clinical outcomes in patients und ergoing a coronary intervention are equivalent when comparing stenting with out balloon predilation with balloon angioplasty followed by stenting. Dire ct stenting is associated with decreased utilization of contrast agent and equipment and shorter procedure times. A randomized study should be perform ed to better determine the impact of this technique on short- and long-term procedural outcomes. (C) 2000 by the American College of Cardiology.