792-5.Three Year Follow-up After Intracoronary Stent Implantation

Abstract

To identify predictors of long-term success following intracoronary stenting, we analyzed clinical outcome in 65 consecutive patients who electively received Palmaz-Schatz stents at least 3 years prior to analysis. 83 stents were successfully inserted in 63 of 65 patients (97%), of whom 49 (75%) were men and 16 (25%) were women, with a mean age (±SD) of 59 ± 9 years, 18 patients (28%) were diabetic. 16 patients (24%) required more than one stent. Indications for stenting included restenosis following prior PTCA (52%) and lesion complexity (43%). 10 patients (15%) received stents in saphenous vein grafts. Demographic, clinical, and procedural predictors of survival and event-free survival at a mean follow-up of 39 ± 17 months were analyzed. Event-free survival was defined as survival without MI, CABG, PTCA at the stent site, or recurrent target vessel ischemia. Survival and event-free survival at 3 years were 86% and 54%, respectively. Predictors of decreased long term survival (p < 0.05) included diabetes, and a high angina score (Canadian Heart Class 3–4) at 6 and 12 months following stenting. Predictors of decreased event-free survival (p < 0.05) included smaller balloon size at implantation, greater number of stents at the primary lesion, and high angina score at each follow-up interval. Freedom from adverse events by 6 months following stenting correlated with long term success. 35 of 44 patients (80%) with event-free survival at 6 months remained event-free at follow-up. During follow-up, 17 patients (27%) developed symptomatic stent restenosis, requiring primarily early revascularization; 18 patients (28%) developed symptomatic stenoses in other vessels, requiring primarily late revascularization. (1) long term survival after stenting is excellent; (2) the need for late revascularization is dictated primarily by disease progression in non-stented vessels; and (3) long-term success of stenting is predicted by freedom from adverse events at 6 months.