Key result
Elective stenting without IVUS plus aspirin alone yields ~1% subacute thrombosis with optimal angiographic results.
Why the study?
Does elective coronary stent implantation with angiographic guidance alone and subsequent aspirin therapy prevent subacute stent thrombosis in patients with optimal angiographic results?
Observational (n=168)
No
Does elective coronary stent implantation with angiographic guidance alone and subsequent aspirin therapy prevent subacute stent thrombosis in patients with optimal angiographic results?
Aspirin alone, without warfarin or intravascular ultrasound guidance, appears sufficient to prevent subacute stent thrombosis after elective coronary stenting if angiographic results are optimal.
May support aspirin monotherapy after optimal angiographic stenting; hypothesis-generating and requires randomized confirmation before practice change.
Two hundred forty-three stents (203 Palmaz-Schatz, 40 Glanturco-Roubin) were electively Implanted in 188 lesions in 168 patients (mean age 58 +/- 10 years, 77% males) using angiographic but not ultrasound guidance. Patients were treated subsequently with aspirin and observed in hospital for up to 7 days. Those with acute myocardial infarction, radiolucent defects in coronary arteries suggestive of thrombus, and results that were not optimal after stent implantation were anticoagulated with warfarin and not Included in the study. Two had subacute stent thrombosis and two patients non-Q-wave myocardial infarction in-hospital. At follow-up (median 149 days) none had had subacute stent thrombosis, one suffered non-Q-wave myocardial infarction, none had died, and none had developed major complications at the vascular access site. Fourteen (8%) had undergone further revascularisation procedures. This initial experience suggests that aspirin is sufficient to prevent subacute stent thrombosis after elective high pressure assisted coronary stent implantation without intravascular ultrasound guidance if the angiographic appearance after stent deployment is optimal.
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Sankardas et al. (1996) conducted an observational in Symptomatic coronary artery disease (n=168). Elective intracoronary stent implantation without IVUS guidance and subsequent aspirin therapy was evaluated on Subacute stent thrombosis in-hospital. Elective intracoronary stent implantation without intravascular ultrasound guidance, followed by aspirin therapy alone, resulted in only a 1% rate of in-hospital subacute stent thrombosis when angiographic results were optimal.
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