Results of coronary stenting for unstable versus stable angina pectoris

https://doi.org/10.1016/S0002-9149(97)00131-8Get rights and content

Abstract

Coronary artery stenting has been shown to improve the short- and long-term results of coronary angioplasty in mainly stable patients with 1-vessel disease, but it is uncertain whether its use in an unstable clinical setting may be safe and useful. To evaluate the stenting efficacy in patients with unstable angina, we retrospectively examined our experience with the Palmaz-Schatz balloon expandable stent in 231 consecutive patients. Patients were divided into 2 groups on the basis of symptoms at the time of stent implantation: group U (132 patients) had unstable angina, and group S (99 patients) had stable angina. After stent insertion, patients were treated with anticoagulant or combined antiplatelet therapy. Baseline characteristics of the 2 groups were comparable with the exception of age (higher in the unstable group) and angiographic characteristics of the target lesions (more unfavorable in unstable patients). In both groups, coronary stenting presented a high procedural success rate. Major in-hospital complications occurred in 9 unstable (6.8%) and in 2 stable (2%) patients (p = NS) and were mainly related to subacute stent thrombosis. In both groups, subacute stent thrombosis mostly occurred in patients treated with anticoagulant therapy (7 of 9 unstable patients, 2 of 2 stable patients). At 6-month follow-up, unstable and stable patients had a similar incidence of death (0%), Q-wave myocardial infarction (0%), and need of coronary artery bypass graft (3.2% vs 4%, p = NS), but coronary angioplasty repetition (4.8% vs 14%, p = 0.027) and target vessel revascularization (6.3% vs 17%, p = 0.019) rates were lower in the unstable group. In conclusion, stent insertion increases the short- and midterm coronary angioplasty effectiveness in unstable angina, making it possible to achieve outcomes quite comparable to stable angina. Compared with conventional anticoagulant regimen, combined antiplatelet therapy after placement of coronary stents seems to reduce the incidence of subacute thrombosis also in this clinical setting.

References (25)

  • E Braunwald

    Classification of unstable angina

    Circulation

    (1989)
  • SG Ellis et al.

    Coronary morphologic and clinical determinants of procedural outcome with angioplasty for multivessel coronary disease: implications for patients selection

    Circulation

    (1990)
  • Cited by (38)

    • 2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines

      2011, Journal of the American College of Cardiology
      Citation Excerpt :

      In a comparison of the use of the Palmaz-Schatz coronary stent in patients with stable angina and patients with UA, no significant differences were found with respect to in-hospital outcome or restenosis rates (597). Another study found similar rates of initial angiographic success and in-hospital major complications in stented patients with UA compared with those with stable angina (598). Major adverse cardiac events at 6 months were also similar between the 2 groups, whereas the need for repeat PCI and target-vessel revascularization was actually less in the UA group.

    • ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction-Executive Summary. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction)...

      2007, Journal of the American College of Cardiology
      Citation Excerpt :

      Published success rates of PCI in patients with UA/NSTEMI are high overall. Outcomes have approached those of elective surgery with the use of stents and potent antiplatelet therapy (207–209). The use of drug-eluting stents for UA/NSTEMI has increased dramatically in recent years, with favorable rates of early death and recurrent infarction (210).

    • ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction)...

      2007, Journal of the American College of Cardiology
      Citation Excerpt :

      In a comparison of the use of the Palmaz-Schatz coronary stent in patients with stable angina and patients with UA, no significant differences were found with respect to in-hospital outcome or restenosis rates (597). Another study found similar rates of initial angiographic success and in-hospital major complications in stented patients with UA compared with those with stable angina (598). Major adverse cardiac events at 6 months were also similar between the 2 groups, whereas the need for repeat PCI and target-vessel revascularization was actually less in the UA group.

    • Early angioplasty in acute coronary syndromes without persistent ST-segment elevation improves outcome but increases the need for six-month repeat revascularization: An analysis of the PURSUIT trial

      2002, Journal of the American College of Cardiology
      Citation Excerpt :

      However, “cooling down” of ACS before PCI may be unfavorable, with respect to 30-day MI and possibly death. In a number of recent trials and PURSUIT sub-analyses, the benefit of intervention over conservative treatment is demonstrated (Fig. 2) (4,22,23). For example, the recently published FRISC-2 trial demonstrated a benefit of intervention versus conservative treatment.

    • Interventional therapy of the acute coronary syndromes

      2002, Progress in Cardiovascular Diseases
    View all citing articles on Scopus
    View full text