Feasibility, safety, cost-effectiveness and 1 year follow-up of coronary stenting without predilation: a matched comparison with the standard approach

Background: We evaluated the feasibility, safety, procedural cost-effective ness, radiation dose and time and 1-year target vessel revascularization ra te of direct unprotected mounted stenting without previous balloon dilatati on (DS) in native coronary artery lesions. Methods: DS was attempted in 119 patients; 39 had a recent myocardial infarction, 62 had unstable angina, a nd 18 had stable angina. The clinical follow-up was obtained at 14 +/- 5 mo nths (range 6 to 24 months). These results were compared with those for a c onsecutive group of 160 patients matched for type and length of lesions and who had a stent only if the post-balloon residual stenosis was > 30%. Resu lts: The feasibility of DS was 112/119 (94%). The number of inflations, the length of the stent/length of the lesion ratio, the time and the dose of r adiation were dramatically lower in the DS group (P < 0.001). DS conferred a slight reduction in procedure-related cost [$820 +/- 157 for DS vs. 894 /- 427 for standard dilatation (SD) per patient]. The 1-year target vessel revascularization rate was similar in both groups [nine (8%) for DS vs. 17 (11%) patients for SD, ns]. Conclusions: DS is feasible and safe in selecte d coronary lesions. This method provides a low rate of repeat revasculariza tion and reduces the time and the dose of radiation compared with the stand ard approach. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.