Comparison of clinical outcome after elective and "bail out" coronary stent insertion.

BACKGROUND

Coronary stents may be used electively during percutaneous transluminal coronary angioplasty (PTCA) or as a "bail-out" device to treat abrupt or threatened vessel closure following PTCA.

OBJECTIVE

To compare the clinical outcome of elective and "bail-out" coronary stent insertion.

DESIGN

A retrospective analysis of all patients receiving coronary stents.

SETTING

Tertiary referral center performing over 400 PTCA procedures a year.

PATIENTS

Fifty-six patients (42 male), mean age 57 (range = 32 to 78) years received 67 Palmaz-Schatz coronary stents. Forty-nine stents were deployed as "bail-out" in 41 patients (abrupt vessel closure in 15 and threatened vessel closure in 26) and 18 stents were deployed electively in 15 patients.

MAIN OUTCOME MEASURES

Myocardial infarction, repeat angiography, coronary artery bypass graft surgery and death.

RESULTS

Stents were successfully deployed in 56/62 (90.3%) patients. In-hospital events were significantly more common in the "bail-out" group compared to the elective group. The in-hospital events, comparing the "bail-out" group versus the elective group, were as follows: Death 2/41 (4.9%) vs 0/15 (0%), coronary artery bypass graft surgery (CABG) 8/41 (19.5%) vs 0/15 (0%), stent thrombosis 3/41 (7.3%) vs 0/15 (0%), and myocardial infarction 6/41 (14.6%) vs 1/15 (6.7%) respectively. After discharge no patient died or had CABG. One patient in the "bail-out" group had a myocardial infarct (late stent thrombosis). Two patients from each group had repeat angiography because of recurrent angina in the 6 month follow up period.

CONCLUSION

"Bail-out" stenting has an increased incidence of in-hospital complications compared to elective procedures. If these short-term problems can be overcome however, the clinical events in the first 6 months after leaving hospital are low and similar to patients under-going elective procedures.