Procedural Results and Late Clinical Outcomes After Placement of Three or More Stents in Single Coronary Lesions

Abstract

Background —Previous reports have suggested higher procedural and long-term complications among patients treated with multiple stents for diffuse lesions and/or long dissections. Methods and Results —To evaluate procedural success, major complications, and clinical outcomes (≥1 year) in a consecutive series of patients treated with multiple (≥3) contiguous stents in single lesions, we evaluated in-hospital and long-term (1-year) clinical outcomes in 117 consecutive patients treated with ≥3 coronary stents compared with a concurrent series of patients treated with 1 or 2 stents (n=1673) between January 1, 1994, and December 31, 1995. Multiple stents were implanted more often in larger vessels, in the right coronary artery or saphenous vein grafts, and for unfavorable lesion characteristics, including long (>20 mm), calcified, ulcerated, thrombotic, and/or flow-obstructing lesions. Overall procedural success was obtained in 97.4% of patients and was similar whether 1 or 2 versus ≥3 stents were used. Non–Q-wave MI (CK-MB ≥5 times normal) was more frequent after ≥3 stents (22.8% versus 13.4%, P =.005). Target lesion revascularization (TLR) was 14.6% for 1 or 2 stents and 13.3% for ≥3 stents ( P =.70). There was no difference in death (2.2% versus 0.9%, P =.34) or Q-wave MI (1.4% versus 0.9%, P =.64) between the two groups (1 or 2 stents versus ≥3 stents, respectively), and overall cardiac event–free survival was similar during follow-up ( P =.70). Conclusions —Patients treated with multiple (≥3) contiguous stents compared with 1 or 2 stents have (1) similar in-hospital procedural success and major complications despite having more unfavorable lesion characteristics, (2) a higher rate of procedural non–Q-wave MI, and (3) similar TLR and overall major cardiac event rates during 1 year of follow-up.