"REAL WORLD" STENTING: A COMPARISON OF OUTCOMES BASED ON BENESTENT/STRESS ELIGIBILITY
C. Arronis*, G. Nashed, B. Corliss, S. Newport, C.P. Juergens, A. Hopkins, H.C. Lowe.
Cardiology Department, Liverpool Hospital, Sydney, New South Wales.
Background: the rationale for stenting is based on two randomised controlled trials, Benestent and STRESS. Many patients currently stented would be ineligible for these trials; outcomes in these ineligible patients might be expected to be worse, but the impact of new devices and techniques is unknown.
Methods: We therefore sought to compare outcomes in all patients stented at this institution, based on whether they would be eligible (group 1) or ineligible (group 2) for Benestent and STRESS. This comparison was made in the first 100 patients stented at our institution, which has provided an Interventional Cardiology service from August 1997. All data were obtained from a computerised database entered at the time of the procedure, with the classification as to eligibility made retrospectively. Telephone follow-up was at 6 months.
Results: 115 lesions in 100 consecutive patients were stented between August 1997 and February 1998 inclusive. Over this period, an additional 26 patients underwent coronary angioplasty without stenting.
|
Trial Eligible (gp1) n = 23 |
Ineligible (gp2 ) n = 77 |
P value* |
|
|
Initial Technical Success |
23 (100%) |
68 (89%) |
0.08 |
|
NQWMI |
0 |
8 (10.4%) |
>0.1 |
|
Re PTCA/CABG/Death |
0 |
1 |
>0.1 |
|
Overall Procedural Success |
23 (100%) |
59 (76.6%) |
<0.01 |
|
Mean Procedural Cost** (sd) |
A$2,533 (571) |
A$2,787.91 (1,141) |
NS |
|
TLR at 6 months |
1 (4.3%) |
7 (9.0%) |
>0.1 |
|
MACE at 6 months |
0 |
2 (2.6%) |
> 0.1 |
TLR = Target Lesion Revascularisation. MACE = Major Adverse Cardiac Events. NQWMI = Non Q Wave Myocardial Infarction.
*Fisher's exact test except ** student's t test.
Conclusions: In this small patient cohort, only 23% of patients stented fulfilled the Benestent/STRESS entry criteria. In those eligible patients, immediate and 6 month outcomes were excellent. Stenting in the ineligible group was associated with lower overall procedural success and a trend toward higher rates of revascularisation and adverse events at 6 months. Procedural costs did not differ significantly between groups.
