From the Deutsches Herzzentrum München and 1. Medizinische Klinik,
Klinikum rechts der Isar, Technische Universität München, Germany.
Correspondence to Dr Helmut Schühlen, 1. Medizinische Klinik der Technischen Universität München, Klinikum rechts der Isar, Ismaninger Str 22, D-81675 München, Germany. E-mail h.schuehlen{at}med1.med.tu-muenchen.de
Background—Our rationale for this
study was to analyze the risk for procedural failure of
attempted stenting and the risk for major adverse cardiac events (MACE)
after success and to develop a risk stratification protocol for
successful procedures.
Methods and Results—Stenting was attempted in 2894 procedures
during the 5-year study period (success in 98.3% of 3815 lesions).
After failure, the MACE rate was 42.6%. The risk for failure was
higher for lesions in the left circumflex coronary artery or in
venous bypass grafts and after an acute occlusion before stenting; it
increased with stenosis length or grade and decreased with
vessel size and growing institutional experience in stenting. After
success, death occurred in 0.8%, death or myocardial infarction in
2.0%, and any MACE in 3.6%. Independent risk factors for MACE were
older age, diabetes, acute myocardial infarction, unstable angina,
impaired left ventricular function, residual dissections,
stent overlap, longer stented segments, and a postprocedural regimen
without ticlopidine. Procedural factors were substantially stronger
predictors than operator-independent variables available before
procedures. Overall, the risk declined after the first 3 days. Two
major factors exhibited time-dependent variations of their influence:
while residual dissections were the dominant risk factor within the
first 3 days with a reduction after that, no protective effect of
ticlopidine could be identified before day 3. From these results, we
derived a risk stratification protocol for individual procedures.
Conclusions—These results underscore the importance of optimal
angiographic results and the need for antiplatelet regimens with
immediate onset. Our risk stratification protocol may guide individual
postprocedural care and allow us to compare risk profiles of different
study populations and to devise quality control programs for stenting.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Intracoronary Stenting and Risk for Major Adverse Cardiac Events During the First Month
Key Words: stents • coronary disease • risk factors • platelet aggregation inhibitors
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