Improved long-term survival associated with stent deployment during percutaneous coronary interventions: Results from a registry of 3399 patients

Introduction The use of stents in percutaneous coronary intervention,(PCI) improves procedural success and reduces restenosis. However, few studies have had a sufficient sample size or adequate follow-up to determine whether this advantage results in 6 positive effect on mortality. Methods A total of 3399 patients undergoing PCI (stented [with dual antiplatelet therapy]: n = 2456, nonstented [balloon PCI or rotational atherectomy]: n = 942) at a Single institution from 1994 to 2001 were followed up prospectively (43 +/- 22 and 54 +/- 25 months, respectively) for acute and long-term clinical outcomes. Results Angiographic success (<50% residual stenosis). (99.7% vs 97.7%, P<.001) and acute gain (3.02 +/- 0.55 vs 2.08 +/- 0.62 mm, P <.001) were both greater for stented lesions. Likewise, procedural complications of death. (0.04% vs 0.4%, P = .02) and dissection (4.9% vs 8.0%, P = .001) were lower in the stent group, as were rates of 6-month clinical restenosis (10.3% vs 16.3%, P <.001). Eight-year mortality (12.0% vs 18.2%, hazard ratio = 0.78, P =.009). was lower among the stent group, as was long-term major adverse cardiac events (36.2% vs 50.6%, P <.001), but no difference in long-term myocardial infarction was found (6.5% vs 7.6%, P =.28). In multivariable Cox regression, stent use (hazard ratio = 0.76, 95% CI [0.58-0.99], P=.04) remained associated with significantly reduced mortality. Conclusion This large prospective study demonstrates that, in addition to a general improvement in procedural success and a reduced need for repeat revascularization, the use of stents with dual antiplatelet therapy was associated with a significant reduction in long-term mortality. Consideration should be given for the use of stents whenever feasible during PCI.