CLINICAL STUDY: INTERVENTIONAL CARDIOLOGY
The effects of contemporary use of coronary stents on in-hospital mortality
Stephen E. Kimmel, MD, MS*  ,
A. Russell Localio, MPH, MS, JD*  ,
Ronald J. Krone, MD, FACC ,
Warren K. Laskey, MD, FACC|| for the Registry Committee of the Society for Cardiac Angiography and Interventions
* Center for Clinical Epidemiology and Biostatistics and Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
Division of Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
|| Cardiovascular Division, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
Manuscript received February 14, 2000;
revised manuscript received August 14, 2000,
accepted November 2, 2000.
Reprint requests and correspondence: Dr. Stephen E. Kimmel, University of Pennsylvania School of Medicine, Center for Clinical Epidemiology and Biostatistics, 717 Blockley Hall, 423 Guardian Drive, Philadelphia, Pennsylvania 19104-6021
skimmel{at}cceb.med.upenn.edu
OBJECTIVES
This study was designed to determine the effect of coronary stents on in-hospital mortality.
BACKGROUND
Despite extensive use of stents for percutaneous coronary interventions (PCIs), their effect on serious in-hospital events, especially mortality, is not well defined.
METHODS
A cohort study was performed using 16,811 consecutive native-vessel PCI procedures performed on patients in the Society for Cardiac Angiography & Interventions Registry from July 1, 1996, through December 31, 1998. Patients undergoing balloon-only angioplasty were compared with those receiving a planned or unplanned stent. Procedures with other devices were excluded. Multivariable analyses adjusted for detailed clinical characteristics and for individual laboratory.
RESULTS
Stents were associated with a significant reduction in in-hospital mortality (0.3%) compared with balloon procedures (0.6%; multivariable odds ratio [OR] 0.55; 95% confidence interval [CI] 0.34, 0.89; p = 0.014). The risk of emergency coronary bypass also was reduced by stenting (0.3% vs. 0.7%; multivariable OR 0.47; 95% CI: 0.29, 0.76; p = 0.002). Adjustment for the use of glycoprotein IIb/IIIa inhibitors did not change the results, and the effects of stenting relative to balloon procedures were similar in those procedures with and without glycoprotein IIb/IIIa blockade (p = 0.94).
CONCLUSIONS
This study suggests that coronary stenting, compared with balloon procedures, reduces in-hospital mortality, independent of the clinical setting.
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Abbreviations and Acronyms
| | CABG | = coronary artery bypass grafting | | CI | = confidence interval | | MI | = myocardial infarction | | OR | = odds ratio | | PCI | = percutaneous coronary intervention | | SCA&I | = Society for Cardiac Angiography and Interventions |
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