In-hospital and late clinical outcomes of direct stenting strategy versus stenting after predilatation for the treatment of coronary artery lesions.

BACKGROUND

Direct stenting without balloon dilatation may reduce procedural costs and duration, and hypothetically, the restenosis rate. This study was designed to compare the in-hospital and long-term outcomes of direct stenting (DS) versus stenting after predilatation (PS) in our routine clinical practice.

METHODS

One thousand six hundred and three patients treated with stenting for single coronary lesions were enrolled into a prospective registry. Patients with acute myocardial infarction (MI) within the preceding 48 hours, highly calcified lesions, total occlusions, or lesion in a saphenous graft were excluded. The baseline, angiographic, and procedural data, in-hospital outcomes and follow-up data were recorded in our database, and analyzed with appropriate statistical methods.

RESULTS

Eight hundred and fifty-seven patients (53.5%) were treated with DS, whereas 746 of them (46.5%) underwent PS. In the DS group, lesions were shorter in length, larger in diameter, and had lower pre-procedural diameter stenosis. Type C and diffuse lesions and drug-eluting stents were less frequent (p < 0.001). In univariate analysis, dissection and non-Q-wave MI occurred less frequently in this group (0.2% and 0.6% vs 3.9% and 2.1%, p < 0.001 and p 7 = 0.01, respectively). However, the cumulative major adverse cardiac events (MACE) did not differ significantly (4.9% vs 4.6%, p = 0.79). In multivariate analysis, direct stenting reduced the risk of dissection (OR = 0.07, 95% CI: 0.01-0.33), but, neither the cumulative endpoint of MACE (OR = 1.1, 95% CI = 0.58-2.11, p = 0.7) nor its constructing components were different between the groups.

CONCLUSIONS

Direct stenting in real world has at least similar long-term outcomes with patients treated with stenting after predilatation and is associated with lower dissection rate.