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Heart 1999;81:393-397 ( April )

Coronary artery stenting in unstable angina pectoris: a comparison with stable angina pectoris

P B M Clarkson, M Halim, K K Ray, S Doshi, M Been, H Singh, M F Shiu

Department of Cardiology, Walsgrave Hospital, Clifford Bridge Road, Coventry CV2, UK

Correspondence to: Dr Clarkson. email: pbclarkson{at}aol.com

Accepted for publication 1 October 1998

OBJECTIVE---To compare early complication rates in unselected cases of coronary artery stenting in patients with stable v unstable angina.
SETTING---Tertiary referral centre.
PATIENTS---390 patients with stable angina pectoris (SAP) and 306 with unstable angina (UAP). Patients treated for acute myocardial infarction (primary angioplasty) or cardiogenic shock were excluded.
INTERVENTIONS---268 coronary stents were attempted in 211 patients (30.3%). Stents used included AVE (63%), Freedom (14%), NIR (7%), Palmaz-Schatz (5%), JO (5%), and Multilink (4%). Intravascular ultrasound was not used in any of the cases. All stented patients were treated with ticlopidine and aspirin together with periprocedural unfractionated heparin.
RESULTS---123 stents were successfully deployed in 99 SAP patients v 132 stents in 103 UAP patients. Failed deployment occurred with nine stents in SAP patients, v four in UAP patients (NS). Stent thrombosis occurred in four SAP patients and 11 UAP patients. Multivariate analysis showed no relation between stent thrombosis and clinical presentation (SAP v UAP), age, sex, target vessel, stent length, or make of stent. Stent thrombosis was associated with small vessel size (p < 0.001) and bailout stenting (p = 0.01) compared with elective stenting and stenting for suboptimal PTCA, with strong trends toward smaller stent diameter (p = 0.052) and number of stents deployed (p = 0.06). Most stent thromboses occurred in vessels < 3 mm diameter.
CONCLUSIONS---Coronary artery stenting in unstable angina is safe in vessels >=  3 mm diameter, with comparable initial success and stent thrombosis rates to stenting in stable angina.

Keywords: angina pectoris; stents


© 1999 by Heart



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