Direct coronary stenting without balloon or device pretreatment: Acute success and long-term results

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.