Clinical and angiographic outcome after angiography-guided stent placement in small coronary vessels

Abstract

Background Although it is widely accepted that stenting confers favorable angiographic and clinical results in coronary arteries ⩾ 3.0 mm in diameter, the outcome of stent placement in smaller vessels remains largely unclear. Methods and results We sought to specifically determine the early and long-term clinical outcomes in a large series of 197 consecutive patients who underwent stent placement in 207 vessels < 3.0 mm in diameter. Procedural success, accomplished in 97.3%, was accompanied by a significant reduction in lesion severity from 85% ±9% before to 3% ± 7% diameter stenois after the procedure ( P = .0001 and a 0.5% incidence of subacute stent thrombosis. At 1 and 2 years of follow-up, survival rate without major target lesion-driven events was observed in 77.3% and 73.9% of patients, respectively. Repeat revascularization procedures accounted for most of these events; cardiac deaths (including those related to subacute stent thrombosis) and late (>30 days) myocardial infarctions were infrequent (2.4% and 1.0%, respectively). The 6-month angiographic binary instent restenosis rate was 30.1%. On multivariate analysis, diabetes mellitus ( P = .0275, small baseline reference vessel size ( P = .0300, and stent size ⩽ 2.7mm ( P = .0111 were idependently associated with an increased instent restenosis rate. Conclusions Optimal angiograpy-guided coronary stenting of vessels < 3.0 mm in diameter in association with the stringent use of a poststent combined aspirin-ticlopidine antiplatelet regimen confers a low risk of stent thrombosis, an acceptable incidence of angiographic instent restenosis, and a favorable long-term clinical outcome.