Clinical and angiographic outcome after angiography-guided stent placementin small coronary vessels

Background Although it is widely accepted that stenting confers favorable a ngiographic and clinical results in coronary arteries greater than or equal to 3.0 mm in diameter, the outcome of stent placement in smaller vessels r emains largely unclear. Methods and Results We sought to specifically determine the early and long- term clinical outcomes in a large series of 197 consecutive patients who un derwent stent placement in 207 vessels <3.0 mm in diameter. Procedural succ ess, accomplished in 97.3%, was accompanied by a significant reduction in l esion severity from 85% +/- 9% before to 3% +/- 7% diameter stenosis after the procedure (P = .0001) and a 0.5% incidence of subacute stent thrombosis . At 1 and 2 years of follow-up, survival rate without major target lesion- driven events was observed in 77.3% and 73.9% of patients, respectively. Re peat revascularization procedures accounted for most of these events; cardi ac deaths (including those related to subacute stent thrombosis) and late ( > 30 days) myocardial infarctions were infrequent (2.4% and 1.0%, respectiv ely). The 6-month angiographic binary instent restenosis rate was 30.1%. On multivariate analysis, diabetes mellitus (P = .0275), small baseline refer ence vessel size (P = .0300), and stent size less than or equal to 2.7 mm ( P = .0111) were independently associated with an increased instent restenos is rate. Conclusions optimal angiography-guided coronary stenting of vessels < 3.0 m m in diameter in association with the stringent use of a poststent combined aspirin-ticlopidine antiplatelet regimen confers a low risk of stent throm bosis, an acceptable incidence of angiographic instent restenosis, and a fa vorable long-term clinical outcome.