Multivessel coronary stenting: predictors of early and late outcome.

BACKGROUND

At present, only few data are available on the early and late outcome following multivessel coronary stenting. Of note, in these studies, the left anterior descending (LAD) artery was treated in less than 40% of cases. These patients may not fully represent the population commonly referred for surgical revascularization.

METHODS

In-hospital and long-term (18 +/- 4 months) events were evaluated in 272 consecutive patients who had multivessel stent implantation including the LAD artery in each case. All clinical, angiographic, and procedural variables were analyzed to identify the predictors of acute and long-term major adverse coronary events.

RESULTS

Eighteen patients (6.6%) had in-hospital major adverse coronary events (death 0.7%, coronary artery bypass grafting 0.4%, and myocardial infarction 6.3%). Acute and subacute stent thrombosis rates were 1.5 and 1.1%, respectively. At 18 +/- 4 months, event-free survival was 71%. Target lesion revascularization was performed in 54 (20%) patients (42 coronary angioplasty and 12 coronary artery bypass grafting). The jeopardy score was the predictor of in-hospital major adverse coronary events (p = 0.016, odds ratio 1.34, 95% confidence interval 1.05-1.69), and diabetes mellitus was the predictor of long-term major adverse coronary events (p = 0.027, odds ratio 2.80, 95 % confidence interval 1.12-6.96).

CONCLUSIONS

Multivessel coronary stent implantation with treatment of the LAD artery in all instances is a safe procedure with low acute and long-term major adverse coronary events. The risk-benefit ratio must be assessed carefully for each patient, particularly taking into account the jeopardy score and the presence of diabetes mellitus.