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J Am Coll Cardiol, 1999; 33:420-426 © 1999 by the American College of Cardiology Foundation |
a Cardiac Catheterization Laboratory, Division of Cardiology, Washington Hospital Center, Washington, D.C., USA
Manuscript received May 14, 1998; revised manuscript received August 21, 1998, accepted October 6, 1998.
Reprint requests and correspondence: Dr. Martin B. Leon, Director, Cardiovascular Research, Washington Cardiology Center, Suite 4B-1, 110 Irving Street, NW, Washington, D.C. 20010
MBL1{at}mhg.edu
Objectives
To evaluate in-hospital and long-term clinical outcomes in a large consecutive series of patients undergoing percutaneous multivessel stent intervention.
Background
High restenosis and recurrent angina rates have limited the clinical outcomes of multivessel coronary angioplasty before stents were available to improve angioplasty results.
Methods
We evaluated in-hospital and long-term clinical outcomes (death, Q-wave myocardial infarction [MI], and repeat revascularization rates at one year) in 398 consecutive patients treated with coronary stents in two (94% of patients) or three native arteries, compared to 1,941 patients undergoing stenting procedure in a single coronary artery between January 1, 1994 and August 29, 1997.
Results
Overall procedural success was obtained in 96% of patients with two- or three-vessel stenting and in 97% of patients with single-vessel stent intervention (p = 0.36). Procedural complications were also similar (3.8% for multivessel versus 2.9% for single vessel, p = 0.14). During follow up, target lesion revascularization was 15% in multivessel and 16% in single-vessel interventions (p = 0.38), and repeat revascularization (calculated per treated patient) was also similar for both groups (20% vs. 21%, p = 0.73). There was no difference in death (1.4% vs. 0.7%, p = 0.26), and Q-wave MI (1.2% vs. 0%, p = 0.02) was lower following multivessel interventions. Overall cardiac event-free survival was similar for both groups (p = 0.52).
Conclusions
Unlike previous conventional angioplasty experiences, multivessel stenting has (1) similar in-hospital procedural success and major complication rates and (2) similar long-term (one year) clinical outcomes compared with single-vessel stenting. Thus, stents may be a viable therapeutic strategy in carefully selected patients with multivessel coronary disease.
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