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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.
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