Palmaz-Schatz stenting for threatened or present occlusion after PTCA resulted in a 95.4% survival rate and 70.7% event-free survival at 2 years, with a 6.9% incidence of subacute stent closure.
Observational (n=339)
Does Palmaz-Schatz stenting improve outcomes in patients with present or threatened occlusion after PTCA?
Palmaz-Schatz stenting for threatened or present vessel closure after PTCA is associated with low mortality and MI rates, providing a long-term event-free rate comparable to uncomplicated PTCA.
BACKGROUND: Abrupt vessel closure after percutaneous transluminal coronary angioplasty (PTCA) is associated with major adverse events. Different surgical and nonsurgical approaches have been advocated to treat or prevent this complication. This study summarizes our 4-year experience with Palmaz-Schatz stenting for the management of 339 patients with present or threatened occlusion after PTCA. METHODS AND RESULTS: Stent implantation was attempted in a total of 339 and 4959 patients with PTCA during the study period and was successful in 327 (96.5%). During the follow-up, events like death, myocardial infarction, need for revascularization (bypass surgery and repeat in-stent angioplasty), and major vascular complications were recorded. Angiographic follow-up at 6 months was performed in 89.3% of the eligible patients. As part of an initial policy, stenting was intended as a bridge to nonemergency bypass surgery in 26 patients. In 301 patients for whom stenting was intended as permanent treatment, early clinical course (first 4 weeks) was characterized by a 1.3% cardiac mortality and a 4.0% nonfatal myocardial infarction rate; bypass surgery was necessary in 1%, and 6.3% required early repeat PTCA. Surgical repair for peripheral vascular complications was required in 5.6%, and major bleeding events were encountered in 9%. The incidence of subacute stent closure was 6.9%, with subsequent recanalization successful in 86%; subacute stent closure was predicted by presence of vessel occlusion before stenting and localization of the stent in a vessel other than the right coronary artery. Survival rate at 2 years was 95.4%, survival without myocardial infarction was 91.1%, and event-free survival was 70.7%. Survival at 2 years was lower for patients with stents in bypass vein grafts and with myocardial infarction after stenting. Six-month control angiography revealed a restenosis rate of 29.6%. CONCLUSIONS: Patients with present or threatened occlusion after PTCA may benefit from Palmaz-Schatz stenting. It is associated with a low mortality and myocardial infarction rate and with a long-term event-free rate comparable to that of uncomplicated PTCA.
Schömig et al. (Thu,) conducted a observational in Coronary angioplasty complicated by dissection with threatened or present vessel closure (n=339). Palmaz-Schatz stenting was evaluated on Event-free survival at 2 years. Palmaz-Schatz stenting for threatened or present occlusion after PTCA resulted in a 95.4% survival rate and 70.7% event-free survival at 2 years, with a 6.9% incidence of subacute stent closure.