'Primary intention' intracoronary stenting guided by angiography alone: a safe approach

Abstract

Objective: To examine the outcome of intracoronary stent placement by 'primary intention', guided by angiography alone, and without the use of postprocedural anticoagulation.

Design: Prospective, observational study.

Setting: Canadian university teaching hospital.

Patients: Patients (n=559) undergoing urgent or elective percutaneous revascularization procedures (n=616) in whom a preprocedural decision to employ coronary stent placement was made. Emergency and bailout stent procedures were excluded.

Intervention: Stents were delivered at high pressure (1616 to 1818 kPa) on balloons matched to the proximal reference segment diameter. Adequacy of stent deployment was judged by angiographic criteria alone. Postprocedural medication included acetylsalicylic acid and ticlopidine. Quantitative coronary angiographic analysis was independently performed. Acute procedural outcomes were prospectively collected. Patients were followed for one year.

Results: All but one patient had a successful angiographic result. Periprocedural death (0.3%), Q wave myocardial infarction (MI) (0%), non-Q MI (1.6%) and stent thrombosis (0.6%) were uncommon events. At one year, 96% of patients were alive and free of MI, while 12% of patients required repeat target lesion revascularization.

Conclusion: A primary intention strategy of intracoronary stenting, guided by angiography alone, is a safe and effective approach to percutaneous coronary revascularization.