Coronary artery stenting outcomes
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Immediate and Short-Term Outcomes of Coronary Artery Stenting
Coronary artery stenting, especially for left main coronary artery (LMCA) disease, has shown excellent immediate procedural success rates, often reaching 100% in elective cases. Early mortality rates are low, particularly in patients who are good candidates for coronary artery bypass grafting (CABG), and the need for urgent revascularization within the first month is relatively uncommon. However, elderly patients and those with complex disease or comorbidities may experience higher rates of procedural complications, including myocardial infarction, emergency CABG, and death, compared to younger or lower-risk patients 13.
Medium- and Long-Term Outcomes: Stenting vs. CABG
Several randomized trials and meta-analyses have compared the long-term outcomes of stenting (percutaneous coronary intervention, PCI) and CABG for unprotected LMCA disease. Over 5 to 10 years, both strategies show similar rates of all-cause mortality, myocardial infarction, and stroke. However, stenting is associated with a higher rate of repeat revascularization compared to CABG, especially beyond the first year. Major adverse cardiac and cerebrovascular events (MACCE) rates are also similar between the two approaches in the long term, though there may be a trend toward more MACCE with stenting as time progresses 25910.
Drug-Eluting Stents: Long-Term Safety and Efficacy
Comparisons between different types of drug-eluting stents (DES), such as polymer-free versus durable polymer DES, reveal no significant differences in long-term outcomes, including cardiac death, myocardial infarction, target lesion revascularization, or stent thrombosis. Both types of DES demonstrate low rates of stent thrombosis over 10 years, but overall adverse event rates remain high, reflecting the complexity of the patient population .
Special Populations and Lesion Characteristics
- Elderly Patients: Elderly individuals (≥75 years) undergoing stenting have higher rates of procedural complications and restenosis compared to younger patients. Their 12-month survival is high, but event-free survival is lower, especially in those with unstable angina, prior MI, low ejection fraction, multivessel disease, or complex lesions .
- Sex Differences: Outcomes after stenting or CABG for left main disease do not differ significantly between men and women after adjusting for baseline characteristics. However, women may have a trend toward worse outcomes after PCI, likely due to higher comorbidity and periprocedural complications .
- Vessel Tortuosity: Stenting in vessels with moderate or severe tortuosity is associated with higher rates of target vessel failure, myocardial infarction, and need for repeat revascularization at both 30 days and 5 years .
- Iatrogenic Dissection: Bailout stenting for guide catheter-induced coronary artery dissection has acceptable immediate and long-term outcomes. Drug-eluting stents may reduce restenosis in stenotic lesions, but dissection recurrence can occur after DES implantation .
Conclusion
Coronary artery stenting provides excellent immediate and good medium- to long-term outcomes for many patients, including those with left main coronary artery disease. While stenting and CABG offer similar long-term survival and rates of major adverse events, stenting is associated with a higher need for repeat revascularization over time. Outcomes can vary based on patient age, comorbidities, lesion complexity, and vessel characteristics. Both stenting and CABG remain viable options, with the choice tailored to individual patient risk profiles and preferences 1234+6 MORE.
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Most relevant research papers on this topic
Coronary artery stenting in the elderly: short-term outcome and long-term angiographic and clinical follow-up.
Elderly patients undergoing coronary artery stenting have higher rates of procedural complications and worse short-term outcomes than younger patients, but overall survival is 91% after 12 months.
Impact of Coronary Artery Tortuosity on Outcomes Following Stenting: A Pooled Analysis From 6 Trials.
Stent implantation in vessels with moderate/severe coronary artery tortuosity is associated with increased rates of target vessel failure due to higher rates of TV-MI and ischemia-driven target vessel revascularization.
Ten-Year Outcomes After Drug-Eluting Stents Versus Coronary Artery Bypass Grafting for Left Main Coronary Disease
Drug-eluting stents and coronary-artery bypass grafting show no significant difference in the incidence of major adverse cardiac or cerebrovascular events after 10 years in patients with left main coronary artery disease.
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