ABSTRACT
Although stents have been implanted in human coronary arteries since 1986, the long-term angiographic outcome of coronary stenting is unknown. We performed 10-year angiographic follow-up in 8 patients who had undergone stent implantation without acute complications or 6-months' restenosis. Analysis of the changes in minimal luminal diameter within the stent and the reference vessel diameter of the stented segment at 10 years do not suggest that atherosclerosis is accelerated or prolonged beyond 6 months within coronary stents.
Subject(s)
Angioplasty, Balloon, Coronary/adverse effects , Angioplasty, Balloon, Coronary/instrumentation , Coronary Angiography , Coronary Disease/diagnostic imaging , Coronary Disease/therapy , Stents , Aged , Angioplasty, Balloon, Coronary/methods , Coronary Disease/classification , Disease Progression , Disease-Free Survival , Female , Follow-Up Studies , Humans , Male , Patient Selection , Prosthesis Design , Prosthesis Failure , Recurrence , Severity of Illness Index , Time Factors , Treatment OutcomeABSTRACT
There have been few clinical reports of the long term results of implantation of long coronary stents. The authors performed a retrospective study of the long term results of 213 implantations of long stents (20 mm long) in 202 patients. These results were compared with those obtained in patients implanted with short stents (< 20 mm long) during the same period (630 implantations in 530 patients). The angiographic and clinical success rates were respectively 96.5 and 95.4% in the "long stent" group compared with 97.2 and 94.9% in the "short stent" group. In the "long stent" group, at 6, 12 and 24 months (follow-up, the cumulative incidence of nex revascularisation procedures of the target lesion were 9.8, 14.3 and 20.6% respectively, whereas the cumulative incidences of major cardiac events (mortality, infarction, angina, coronary bypass surgery and angioplasty) for the same periods were 12.7, 21.1 and 40% respectively. There was no significant differences compared with the "short stent" group concerning all these events. However, after 6 months, there was a tendency for more major cardiac events and for more new revascularisation procedures of the target lesion in the "long stent" group. In multivariate analysis, the independent predictive factors for major cardiac events were: a Jeopardy score > 6 (p = 0.002), and the complex nature of the lesion (B2 or C) (p = 0.045), whereas the indépendant risk factors for a new revascularisation procedure of the target lesion were: minimal luminal diameter after the procedure, a Jeopardy score > 6, complex lesions, diabetes and the reference diameter of the stented arterial segment. The authors conclude that although the length of the stent as such is not a long term predictive factor, the complexity of the lesion and the severity of the coronary disease which are more common in the "long stent" group explain the non-significant tendency for a higher incidence of major cardiac events in this group.
Subject(s)
Coronary Disease/therapy , Myocardial Revascularization/methods , Stents , Aged , Angina Pectoris/epidemiology , Angina Pectoris/etiology , Angioplasty , Coronary Artery Bypass , Coronary Disease/mortality , Equipment Design , Female , Humans , Incidence , Male , Middle Aged , Myocardial Infarction/epidemiology , Myocardial Infarction/etiology , Myocardial Revascularization/instrumentation , Prognosis , Recurrence , Retrospective Studies , Severity of Illness Index , Treatment OutcomeABSTRACT
PURPOSE: This study was aimed at evaluating the prevalence of peripheral arterial disease of the lower extremities and its prognostic value in a population of patients from the Haute-Garonne department, who were hospitalized for acute coronary artery disease. METHODS: Between 1985 and 1991, four thousands three hundred and sixty-eight patients (3,680 males and 688 females) presenting with acute coronary artery disease were included in the study. RESULTS: The prevalence of peripheral arterial disease of the lower extremities was 13.4%, increasing with age and being higher in male patients. In regard to patients hospitalized for acute myocardial infarction (n = 2,417), independent relationships were observed between the 28-day mortality and the following: patient's age (odds ratio: 1.02; 95% confidence interval: 1.01-1.04; P < 0.0005), female gender (odds ratio: 1.32; 95% confidence interval: 1.17-1.54; P < 0.002), inclusion in the study (odds ratio 0.95; 95% confidence interval: 0.90-0.99; P < 0.02), previous coronary artery disease (odds ratio: 2.88; 95% confidence interval: 2.32-3.48; P < 0.0001), and peripheral arterial disease (odds ratio: 1.61; 95% confidence interval: 1.26-2.06; P < 0.0001). CONCLUSION: The prevalence of peripheral arterial disease of the lower extremities is high in patients with acute coronary artery disease in both genders, whatever the age. This disease is therefore an independent marker of mortality for acute myocardial infarction. Easy diagnosis of peripheral arterial disease of the lower limbs by measurement of the ankle pressure index allows identification of patients prone to death from acute myocardial infarction.
