Elective Coronary Stenting as an Adjunct to Balloon Angioplasty in Stable Coronary Artery Disease: No Association with Incidence of Acute Complications. Results of the PTCA Registry of the German Community Hospitals

Background: Elective coronary stenting has hem shown to reduce the rate of recurrent stenoses after angioplasty but no firm data are available on its possible association with in‐hospital ischemic complications. Methods: We analyzed the data of the registry of the German community hospitals covering approximately one quarter of all interventions in Germany. We included all angioplasty procedures performed in patients with stable coronary artery disease in 1996. Interventions with elective coronary stenting were compared to those with conventional balloon angioplasty. Interventions with bailout stenting were excluded. Results: Of 19,170 angioplasty procedures, 32.2% included elective coronary stenting. The immediate angiographic success rate (residual stenosis < 50%) was 90.6% of the procedures with stents versus 86.3% of those without stents (P < 0.001). The overall incidence of complications (death, myocardial infarction, bypass surgery, vessel closure, reintervention) was 3.9% and 3.8% (NS). Major events (death, myocardial infarction, bypass surgery) were more common in the stent‐treated group (1.8% vs 1.4%, P = 0.027). In multivariate analysis, the following factors were significantly associated with complications: residual stenosis ≥ 50%, female gender, angioplasty of proximal left anterior descending coronary artery, morphological fype of lesion B2 or C, and multivessel disease. Angioplasty of restenoses after previous angioplasty was associated with significantly less risk than of de novo lesions. Stents were neutral with respect to the overall incidence of complications. Conclusions: Complications after elective coronary angioplasty remain largely unpredictable in individual patients despite the identification of several clinical and procedural risk factors. Elective coronary stenting is not associated with the immediate therapeutic risk of angioplasty in stable coronary artery disease.