Coronary stents: a safe and effective intervention for treating coronary artery disease

ABSTRACT

Percutaneous Transluminal Coronary Angioplasty (PTCA) is a less invasive form of coronary revascularisation than Coronary Artery Bypass Grafting (CABG). The major limitation of PTCA is renarrowing of the dilated lesion (restenosis), which may occur in up to one-third of cases. Stents are the only new devices proven to lower the restenosis rate. To evaluate the efficacy and safety of coronary stent implantation, we reviewed the charts of the first 121 patients (133 stents) undergoing coronary stenting using the J & J Stent at Emory University Hospital. Age of the patients studied (yrs; mean ñ SD) was 60.5 ñ 10.5. 77 percent were male, 46 percent were hypertensive and 27 percent were diabetic. 82 percent had class 3 or 4 angina. Prior surgical revascularisation was performed in 66 percent, previous PTCA in 55 percent and previous PTCA to stented vessel in 19.5 percent. Multivessel disease was present in 74 percent. The mean ejection fraction was 52 ñ 11.8 percent. The target lession was located in- a saphenous vein graft in 60.3 percent. The mean baseline diameter stenosis was 80.2 ñ 11.2 percent and this was reduced to 8.8 ñ 8.2 percent after stenting. The stent/s were successfully deployed in 98.6 percent of cases. In hospital clinical success was defined as procedural success in the absence of in-hospital death (0.8 percent), Q-wave myocardinal infarct (MI) (1.7 percent), repeat PTCA (3.3 percent), or emergent CABG (2.5 percent). At a mean follow up of 2.5 years the incidence of death was 11 percent, subsequent MI (15.2 percent), CABG (26.6 percent) and repeat PTCA (39.6 percent). Restenosis was defined as more than 50 percent residual diameter stenosis of the previously dilated coronary segment on follow up angiography. Follow up angiography was performed in 34 of the 121 stented patients because of recurrence of symptoms or a positive stress test. 16 patients had restenosis (15 percent of 121 patients). Coronary stents can be successfully implanted with low hospital morbidity and mortality. Stents markedly reduce the diameter stenosis of the coronary lesion during PTCA. The incidence of restenosis after stenting is low.(AU)