Elective coronary stenting as an adjunct to balloon angioplasty in stable coronary artery disease: No association with incidence of acute complications. Results of the PTCA registry of the German community hospitals

Background: Elective coronary stenting has been shown to reduce the rate of recurrent stenoses after angioplasty but no firm data are available an its possible association with in-hospital ischemic complications. Methods: We analyzed the data of the registry of the German community hospitals coverin g approximately one quarter of all interventions in Germany. We included al l angioplasty procedures performed in patients with stable coronary artery disease in 1996 Interventions with elective coronary stenting were compared to those with conventional balloon angioplasty. Interventions with bailout stenting were excluded. Results: Of 19,170 angioplasty procedures, 32.2% i ncluded elective coronary stenting. The immediate angiographic success rate (residual stenosis < 50%) was 90.6% of the procedures with stents versus 8 6.3% of those without stents (P < 0. 001). The overall incidence of complic ations (death, myocardial infarction, bypass surgery, vessel closure, reint ervention) was 3.9% and 3.8% (NS). Major events (death, myocardial infarcti on, bypass surgery) were more common in the stent-treated group (1.8% vs 1. 4%, P = 0.027). In multivariate analysis, the following factors were signif icantly associated with complications: residual stenosis 50%, female gender , angioplasty of proximal left anterior descending coronary artery, morphol ogical type of lesion B2 or C, and multivessel disease. Angioplasty of rest enoses after previous angioplasty was associated with significantly less ri sk than of de novo lesions. Stents were neutral with respect to the overall incidence of complications. Conclusions: Complications after elective coro nary angioplasty remain largely unpredictable in individual patients despit e the identification of several clinical and procedural risk factors. Elect ive coronary stenting is not associated with the immediate therapeutic risk of angioplasty in stable coronary artery disease.