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CLINICAL STUDIES

Immediate and late outcomes after direct stent implantation without balloon predilation

^a Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, Minnesota, USA

Manuscript received June 11, 1999; revised manuscript received October 26, 1999, accepted December 2, 1999.

Reprint requests and correspondence: Dr. David R. Holmes, Jr., Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905
holmes.david{at}mayo.edu

OBJECTIVES

The aim of our study was to compare the in-hospital and long-term clinical outcomes of direct coronary stenting with balloon predilation followed by stent placement.

BACKGROUND

With improvement in stent designs, the practice of direct stenting without balloon predilation has become more widespread.

METHODS

We analyzed the Mayo Clinic Coronary Intervention data base between January 1, 1995 and March 5, 1999 and identified 777 patients who were treated with direct stenting (DS) and 3,176 patients treated with balloon angioplasty plus stenting (BA+S).

RESULTS

The procedural success rates between the DS and BA+S groups were not significantly different (96.3% vs. 96.4%). The ability to deliver the stent in a subgroup of patients who had DS was 95%, with 5% requiring crossover to predilation. Multivariate analysis showed no significant differences with respect to in-hospital death (odds ratio [OR] 0.9, 95% confidence interval [CI] 0.5 to 1.8), in-hospital myocardial infarction (OR 0.9, 95% CI 0.6 to 1.2) or revascularization (OR 0.7, 95% CI 0.4 to 1.5) in the DS compared with the BA+S group. Long-term outcomes were not significantly different between the DS and BA+S groups. The procedural duration was significantly shorter in the DS group, and there was a decreased utilization of contrast agent, balloons and wires.

CONCLUSIONS

The in-hospital and long-term clinical outcomes in patients undergoing a coronary intervention are equivalent when comparing stenting without balloon predilation with balloon angioplasty followed by stenting. Direct stenting is associated with decreased utilization of contrast agent and equipment and shorter procedure times. A randomized study should be performed to better determine the impact of this technique on short- and long-term procedural outcomes.

Abbreviations and Acronyms   BA+S = balloon angioplasty plus stenting   CABG = coronary artery bypass graft surgery   CI = confidence interval   DS = direct stenting   MI = myocardial infarction   OR = odds ratio   SVG = saphenous vein graft   TIMI = Thrombolysis in Myocardial Infarction

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