T. Stys et al., Direct coronary stenting without balloon or device pretreatment: Acute success and long-term results, CATHET C IN, 54(2), 2001, pp. 158-163
Improvements in coronary stents have made planned direct coronary stenting
technically feasible, though safety, acute success, cost-effectiveness, and
long-term results remain to be determined. Sequential patients eligible fo
r direct stenting were prospectively characterized and treated with either
direct or secondary stenting. Major adverse cardiovascular events (MACE) su
ch as cardiac death, myocardial infarction (MI), target vessel ischemia, or
revascularization (TVR) were followed for 6 months post-PCI. Enrollment in
cluded 128 direct (1.38 lesions/patient) and 69 secondary (1.39 lesions/pat
ient) stented patients. Direct stenting was successful in 99% (with 5% cros
sover to secondary stenting) without major procedural complications and wit
h a similar rate of vessel wall dissection or no-ref low phenomenon (2.3% v
s. 2.1%; P > 0.05) as the secondary stenting group. There was a trend towar
d less postprocedural CPK-MB elevation in the nonacute MI patients with dir
ect vs. secondary stenting (3% vs. 11%, respectively). At 6 months, there w
ere no statistically significant differences in overall MACE. Direct stenti
ng has a high success rate, low complication rate, and durable long-term re
sults. Procedural cost and time savings, less contrast use and radiation ex
posure make direct stenting attractive in properly selected patients. (C) 2
001 Wiley-Liss, Inc.