Long-term outcome in patients treated by intracoronary stenting with ticlopidine and aspirin, and deleterious prognostic role of unstable angina pectoris

Compared with stable clinical conditions, unstable angina carries an increa sed risk of immediate and delayed cardiac adverse events after balloon coro nary angioplasty. The influence of stent use in reducing these differences remains unknown. We analyzed the early (30 days) and late outcome of a coho rt of 459 consecutive patients who underwent stent placement with ticlopidi ne and aspirin as antithrombotic regimen according to the presence (group 1 , n = 151) or absence (group 2, n = 308) of unstable angina at rest (Braunw ald classes II and III). Group 1 patients were older and more likely to be current or former smokers. In group 2, prior myocardial infarction was more frequent. Procedural, in-hospital results, and early outcome were similar in the 2 groups. However, over the long term, the incidence of myocardial i nfarction (11% vs 6%, p <0.04), target lesion revascularization (19% vs 13% , p <0.04), or any revascularization (30% vs 20%, p <0.01) was significantl y higher in group 1. Kaplan-Meier probabilities of survival without myocard ial infarction (85% vs 91%, p <0.05), survival without revascularization of the target lesion (73% vs 83%, p <0.01), survival without any revasculariz ation (65% vs 77%, p <0.006), and survival without any events (61% vs 73%, p <0.009) were significantly worse in group 1. In addition, Cox multivariat e analysis showed that unstable angina at rest was an independent predictor of target lesion revascularization, of survival without any revascularizat ion, and without any events. Thus, unstable angina at rest remains an adver se prognostic indicator in patients treated with intracoronary stents, part icularly with regard to subsequent requirement of revascularization procedu res and event-free survival. (C) 2000 by Excerpta Medica, Inc.