A comparison of short- and long-term outcomes for balloon angioplasty and coronary stent placement

OBJECTIVES We sought to compare patient outcomes for coronary stent placeme nt and balloon angioplasty. BACKGROUND Since 1994, the number of patients treated only with balloon ang ioplasty has decreased nationally, whereas the use of coronary stents as an alternative has grown tremendously. The objectives of this study were to c ompare short- and long-term survival and subsequent revascularization rates for patients undergoing single-vessel balloon angioplasty and coronary ste nt placement. METHODS New York's Coronary Angioplasty Registry was used to identify New Y ork patients undergoing either balloon angioplasty or stent placement betwe en July 1, 1994, and December 31, 1996. Statistical models were used to com pare risk-adjusted short- and long-term survival and subsequent coronary ar tery bypass graft surgery (CABG) and percutaneous coronary interventions (P CIs). RESULTS No significant differences were found in adjusted in-patient mortal ity, but patients who had balloon angioplasty were, on average, 1.36 times more likely to have died at any time during the two-year period after the i ndex procedure (p = 0.003). The adjusted in-patient CABG rate was significa ntly higher for balloon angioplasty (2.72% vs. 1.66%, p < 0.0001), and the adjusted two-year CABG rate nas also significantly higher for balloon angio plasty (10.81% vs. 7.25%, p < 0.001). The adjusted two-year rate for subseq uent PCIs was also significantly higher for balloon angioplasty (19.6% vs. 14.3%, p < 0.0001). Although measures were taken to eliminate or minimize t he effect of selection bias, it should be noted that patients with stents m ere healthier at hospital admission than patients who had balloon angioplas ty. CONCLUSIONS Stent placement is associated with significantly lower risk-adj usted long-term mortality, CABG and subsequent PCI rates, as compared with balloon angioplasty. (C) 2000 by the American College of Cardiology.