The independent value of a direct stenting strategy on early and late clinical outcomes in patients undergoing elective percutaneous coronary intervention.

MedStar author(s):
Citation: Catheterization & Cardiovascular Interventions. 81(6):949-56, 2013 May.PMID: 22888029Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Comparative Study | Journal ArticleSubject headings: *Angioplasty, Balloon, Coronary/is [Instrumentation] | *Coronary Artery Disease/th [Therapy] | *Percutaneous Coronary Intervention/is [Instrumentation] | *Stents | Aged | Angioplasty, Balloon, Coronary/ae [Adverse Effects] | Angioplasty, Balloon, Coronary/mo [Mortality] | Coronary Angiography | Coronary Artery Disease/di [Diagnosis] | Coronary Artery Disease/mo [Mortality] | Coronary Restenosis/et [Etiology] | Coronary Thrombosis/et [Etiology] | Female | Humans | Linear Models | Male | Middle Aged | Myocardial Infarction/et [Etiology] | Percutaneous Coronary Intervention/ae [Adverse Effects] | Percutaneous Coronary Intervention/mo [Mortality] | Propensity Score | Risk Factors | Time Factors | Treatment Outcome | Ultrasonography, InterventionalYear: 2013Local holdings: Available online from MWHC library: 1996 - present, Available in print through MWHC library: 1996 - 2006ISSN:
  • 1522-1946
Name of journal: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & InterventionsAbstract: BACKGROUND: The safety of PCI with DS has been established, but the independent advantages of this technique are not entirely clear.CONCLUSION: During elective PCI, DS decreases overall procedure time and resource utilization, but fails to reveal an independent clinical advantage as there is no demonstrable benefit in regard to the incidence of PPMI, restenosis, or overall clinical outcomes up to 1-year of follow-up. Copyright 2013 Wiley Periodicals, Inc.METHODS: Patients undergoing elective PCI from January 2000 to December 2010 were included. The postprocedural and late clinical outcomes of 444 patients who underwent PCI with DS were compared with a propensity-matched population of 444 subjects treated with PD.OBJECTIVES: This study aimed to compare percutaneous coronary intervention (PCI) with direct stenting (DS) to balloon predilatation (PD) for patients undergoing elective PCI to determine whether there is an independent value for DS with regard to clinical outcomes.RESULTS: The two groups were well matched to 27 baseline clinical, procedural, and angiographic characteristics, thus allowing for a more accurate evaluation of the independent value of the stenting technique. Intravascular ultrasound was used in more than 60% of interventions in both groups. PCI performed with PD were longer (DS 45 +/- 19.28 vs. PD 56 +/- 23.72 minutes, P = 0.001), used more contrast (DS 154 +/- 65.88 vs. PD 186 +/- 92.84 cc, P = 0.001), and more frequently used balloon postdilation (DS 0% vs. PD 27.3%, P = 0.001). The incidence of periprocedural myocardial infarction (PPMI) was similar between DS- and PD patients (5.3% vs. 5.4%, P = 0.91). Likewise, the 1-year rates of major adverse cardiac events (8.4% vs. 6.3%, P = 0.25), target lesion revascularization (3.9% vs. 2.5%, P = 0.24), and definite stent thrombosis (0.2% vs. 0.9%, P = 0.37) were similar among DS and PD patients, respectively.All authors: Kent KM, Laynez-Carnicero A, Lindsay J, Pichard AD, Sardi GL, Satler LF, Suddath WO, Torguson R, Waksman R, Xue ZFiscal year: FY2013Digital Object Identifier: Date added to catalog: 2013-12-24
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 22888029 Available 22888029

Available online from MWHC library: 1996 - present, Available in print through MWHC library: 1996 - 2006

BACKGROUND: The safety of PCI with DS has been established, but the independent advantages of this technique are not entirely clear.

CONCLUSION: During elective PCI, DS decreases overall procedure time and resource utilization, but fails to reveal an independent clinical advantage as there is no demonstrable benefit in regard to the incidence of PPMI, restenosis, or overall clinical outcomes up to 1-year of follow-up. Copyright 2013 Wiley Periodicals, Inc.

METHODS: Patients undergoing elective PCI from January 2000 to December 2010 were included. The postprocedural and late clinical outcomes of 444 patients who underwent PCI with DS were compared with a propensity-matched population of 444 subjects treated with PD.

OBJECTIVES: This study aimed to compare percutaneous coronary intervention (PCI) with direct stenting (DS) to balloon predilatation (PD) for patients undergoing elective PCI to determine whether there is an independent value for DS with regard to clinical outcomes.

RESULTS: The two groups were well matched to 27 baseline clinical, procedural, and angiographic characteristics, thus allowing for a more accurate evaluation of the independent value of the stenting technique. Intravascular ultrasound was used in more than 60% of interventions in both groups. PCI performed with PD were longer (DS 45 +/- 19.28 vs. PD 56 +/- 23.72 minutes, P = 0.001), used more contrast (DS 154 +/- 65.88 vs. PD 186 +/- 92.84 cc, P = 0.001), and more frequently used balloon postdilation (DS 0% vs. PD 27.3%, P = 0.001). The incidence of periprocedural myocardial infarction (PPMI) was similar between DS- and PD patients (5.3% vs. 5.4%, P = 0.91). Likewise, the 1-year rates of major adverse cardiac events (8.4% vs. 6.3%, P = 0.25), target lesion revascularization (3.9% vs. 2.5%, P = 0.24), and definite stent thrombosis (0.2% vs. 0.9%, P = 0.37) were similar among DS and PD patients, respectively.

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