Skip to main content
PMC home page
Heart logoLink to Heart
. 1999 Apr;81(4):393–397. doi: 10.1136/hrt.81.4.393

Coronary artery stenting in unstable angina pectoris: a comparison with stable angina pectoris

P Clarkson 1, M Halim 1, K Ray 1, S Doshi 1, M Been 1, H Singh 1, M Shiu 1
PMCID: PMC1729012  PMID: 10092566

Abstract

OBJECTIVE—To compare early complication rates in unselected cases of coronary artery stenting in patients with stable v unstable angina.
SETTING—Tertiary referral centre.
PATIENTS—390 patients with stable angina pectoris (SAP) and 306 with unstable angina (UAP). Patients treated for acute myocardial infarction (primary angioplasty) or cardiogenic shock were excluded.
INTERVENTIONS—268 coronary stents were attempted in 211 patients (30.3%). Stents used included AVE (63%), Freedom (14%), NIR (7%), Palmaz-Schatz (5%), JO (5%), and Multilink (4%). Intravascular ultrasound was not used in any of the cases. All stented patients were treated with ticlopidine and aspirin together with periprocedural unfractionated heparin.
RESULTS—123 stents were successfully deployed in 99 SAP patients v 132 stents in 103 UAP patients. Failed deployment occurred with nine stents in SAP patients, v four in UAP patients (NS). Stent thrombosis occurred in four SAP patients and 11 UAP patients. Multivariate analysis showed no relation between stent thrombosis and clinical presentation (SAP v UAP), age, sex, target vessel, stent length, or make of stent. Stent thrombosis was associated with small vessel size (p < 0.001) and bailout stenting (p = 0.01) compared with elective stenting and stenting for suboptimal PTCA, with strong trends toward smaller stent diameter (p = 0.052) and number of stents deployed (p = 0.06). Most stent thromboses occurred in vessels < 3 mm diameter.
CONCLUSIONS—Coronary artery stenting in unstable angina is safe in vessels ⩾ 3 mm diameter, with comparable initial success and stent thrombosis rates to stenting in stable angina.

 Keywords: angina pectoris; stents

Full Text

The Full Text of this article is available as a PDF (108.5 KB).

Figure 1  .

Figure 1  

Open in a new tab

Percentages of stents deployed for elective, suboptimal, and bailout indications in patients with stable and unstable angina pectoris.

Figure 2  .

Figure 2  

Open in a new tab

Number of vessels in which stent implantation was performed, separated by vessel type in stable and unstable angina pectoris. LAD, left anterior descending coronary artery (including diagonal lesions); RCA, right coronary artery; Cx, circumflex coronary artery (including obtuse marginal lesions); SVG, saphenous vein graft; L main, left main stem artery (all protected by previous coronary surgery).

Figure 3  .

Figure 3  

Open in a new tab

Diameter of vessels stented in patients with stable and unstable angina pectoris.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Block P. C., Myler R. K., Stertzer S., Fallon J. T. Morphology after transluminal angioplasty in human beings. N Engl J Med. 1981 Aug 13;305(7):382–385. doi: 10.1056/NEJM198108133050706. [DOI] [PubMed] [Google Scholar]
  2. Colombo A., Goldberg S. L., Almagor Y., Maiello L., Finci L. A novel strategy for stent deployment in the treatment of acute or threatened closure complicating balloon coronary angioplasty. Use of short or standard (or both) single or multiple Palmaz-Schatz stents. J Am Coll Cardiol. 1993 Dec;22(7):1887–1891. doi: 10.1016/0735-1097(93)90774-u. [DOI] [PubMed] [Google Scholar]
  3. DeWood M. A., Spores J., Notske R., Mouser L. T., Burroughs R., Golden M. S., Lang H. T. Prevalence of total coronary occlusion during the early hours of transmural myocardial infarction. N Engl J Med. 1980 Oct 16;303(16):897–902. doi: 10.1056/NEJM198010163031601. [DOI] [PubMed] [Google Scholar]
  4. Fischman D. L., Leon M. B., Baim D. S., Schatz R. A., Savage M. P., Penn I., Detre K., Veltri L., Ricci D., Nobuyoshi M. A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. Stent Restenosis Study Investigators. N Engl J Med. 1994 Aug 25;331(8):496–501. doi: 10.1056/NEJM199408253310802. [DOI] [PubMed] [Google Scholar]
  5. Foley J. B., Brown R. I., Penn I. M. Thrombosis and restenosis after stenting in failed angioplasty: comparison with elective stenting. Am Heart J. 1994 Jul;128(1):12–20. doi: 10.1016/0002-8703(94)90004-3. [DOI] [PubMed] [Google Scholar]
  6. George B. S., Voorhees W. D., 3rd, Roubin G. S., Fearnot N. E., Pinkerton C. A., Raizner A. E., King S. B., Holmes D. R., Topol E. J., Kereiakes D. J. Multicenter investigation of coronary stenting to treat acute or threatened closure after percutaneous transluminal coronary angioplasty: clinical and angiographic outcomes. J Am Coll Cardiol. 1993 Jul;22(1):135–143. doi: 10.1016/0735-1097(93)90827-n. [DOI] [PubMed] [Google Scholar]
  7. Goldberg S. L., Colombo A., Nakamura S., Almagor Y., Maiello L., Tobis J. M. Benefit of intracoronary ultrasound in the deployment of Palmaz-Schatz stents. J Am Coll Cardiol. 1994 Oct;24(4):996–1003. doi: 10.1016/0735-1097(94)90861-3. [DOI] [PubMed] [Google Scholar]
  8. Haude M., Erbel R., Issa H., Straub U., Rupprecht H. J., Treese N., Meyer J. Subacute thrombotic complications after intracoronary implantation of Palmaz-Schatz stents. Am Heart J. 1993 Jul;126(1):15–22. doi: 10.1016/s0002-8703(07)80005-6. [DOI] [PubMed] [Google Scholar]
  9. Haude M., Erbel R., Straub U., Dietz U., Schatz R., Meyer J. Results of intracoronary stents for management of coronary dissection after balloon angioplasty. Am J Cardiol. 1991 Apr 1;67(8):691–696. doi: 10.1016/0002-9149(91)90523-n. [DOI] [PubMed] [Google Scholar]
  10. Herrmann H. C., Buchbinder M., Clemen M. W., Fischman D., Goldberg S., Leon M. B., Schatz R. A., Tierstein P., Walker C. M., Hirshfeld J. W., Jr Emergent use of balloon-expandable coronary artery stenting for failed percutaneous transluminal coronary angioplasty. Circulation. 1992 Sep;86(3):812–819. doi: 10.1161/01.cir.86.3.812. [DOI] [PubMed] [Google Scholar]
  11. Jović A., Troskot R. Recovery of atrial systolic function after pharmacological conversion of chronic atrial fibrillation to sinus rhythm: a Doppler echocardiographic study. Heart. 1997 Jan;77(1):46–49. doi: 10.1136/hrt.77.1.46. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Lenfant C. NHLBI funding policies. Enhancing stability, predictability, and cost control. Circulation. 1994 Jul;90(1):1–1. doi: 10.1161/01.cir.90.1.1. [DOI] [PubMed] [Google Scholar]
  13. Liu M. W., Voorhees W. D., 3rd, Agrawal S., Dean L. S., Roubin G. S. Stratification of the risk of thrombosis after intracoronary stenting for threatened or acute closure complicating coronary balloon angioplasty: a Cook registry study. Am Heart J. 1995 Jul;130(1):8–13. doi: 10.1016/0002-8703(95)90228-7. [DOI] [PubMed] [Google Scholar]
  14. MacIsaac A. I., Ellis S. G., Muller D. W., Topol E. J., Whitlow P. L. Comparison of three coronary stents: clinical and angiographic outcome after elective placement in 134 consecutive patients. Cathet Cardiovasc Diagn. 1994 Nov;33(3):199–204. doi: 10.1002/ccd.1810330302. [DOI] [PubMed] [Google Scholar]
  15. Mak K. H., Belli G., Ellis S. G., Moliterno D. J. Subacute stent thrombosis: evolving issues and current concepts. J Am Coll Cardiol. 1996 Feb;27(2):494–503. doi: 10.1016/0735-1097(95)00466-1. [DOI] [PubMed] [Google Scholar]
  16. Malosky S. A., Hirshfeld J. W., Jr, Herrmann H. C. Comparison of results of intracoronary stenting in patients with unstable vs. stable angina. Cathet Cardiovasc Diagn. 1994 Feb;31(2):95–101. doi: 10.1002/ccd.1810310202. [DOI] [PubMed] [Google Scholar]
  17. Mizuno K., Satomura K., Miyamoto A., Arakawa K., Shibuya T., Arai T., Kurita A., Nakamura H., Ambrose J. A. Angioscopic evaluation of coronary-artery thrombi in acute coronary syndromes. N Engl J Med. 1992 Jan 30;326(5):287–291. doi: 10.1056/NEJM199201303260502. [DOI] [PubMed] [Google Scholar]
  18. Mudra H., Klauss V., Blasini R., Kroetz M., Rieber J., Regar E., Theisen K. Ultrasound guidance of Palmaz-Schatz intracoronary stenting with a combined intravascular ultrasound balloon catheter. Circulation. 1994 Sep;90(3):1252–1261. doi: 10.1161/01.cir.90.3.1252. [DOI] [PubMed] [Google Scholar]
  19. Nath F. C., Muller D. W., Ellis S. G., Rosenschein U., Chapekis A., Quain L., Zimmerman C., Topol E. J. Thrombosis of a flexible coil coronary stent: frequency, predictors and clinical outcome. J Am Coll Cardiol. 1993 Mar 1;21(3):622–627. doi: 10.1016/0735-1097(93)90093-g. [DOI] [PubMed] [Google Scholar]
  20. Roubin G. S., Cannon A. D., Agrawal S. K., Macander P. J., Dean L. S., Baxley W. A., Breland J. Intracoronary stenting for acute and threatened closure complicating percutaneous transluminal coronary angioplasty. Circulation. 1992 Mar;85(3):916–927. doi: 10.1161/01.cir.85.3.916. [DOI] [PubMed] [Google Scholar]
  21. Schömig A., Kastrati A., Mudra H., Blasini R., Schühlen H., Klauss V., Richardt G., Neumann F. J. Four-year experience with Palmaz-Schatz stenting in coronary angioplasty complicated by dissection with threatened or present vessel closure. Circulation. 1994 Dec;90(6):2716–2724. doi: 10.1161/01.cir.90.6.2716. [DOI] [PubMed] [Google Scholar]
  22. Serruys P. W., Strauss B. H., Beatt K. J., Bertrand M. E., Puel J., Rickards A. F., Meier B., Goy J. J., Vogt P., Kappenberger L. Angiographic follow-up after placement of a self-expanding coronary-artery stent. N Engl J Med. 1991 Jan 3;324(1):13–17. doi: 10.1056/NEJM199101033240103. [DOI] [PubMed] [Google Scholar]
  23. Serruys P. W., de Jaegere P., Kiemeneij F., Macaya C., Rutsch W., Heyndrickx G., Emanuelsson H., Marco J., Legrand V., Materne P. A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. Benestent Study Group. N Engl J Med. 1994 Aug 25;331(8):489–495. doi: 10.1056/NEJM199408253310801. [DOI] [PubMed] [Google Scholar]
  24. Shaknovich A. Complications of coronary stenting. Coron Artery Dis. 1994 Jul;5(7):583–589. doi: 10.1097/00019501-199407000-00005. [DOI] [PubMed] [Google Scholar]
  25. Sigwart U., Puel J., Mirkovitch V., Joffre F., Kappenberger L. Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty. N Engl J Med. 1987 Mar 19;316(12):701–706. doi: 10.1056/NEJM198703193161201. [DOI] [PubMed] [Google Scholar]
  26. Sutton J. M., Ellis S. G., Roubin G. S., Pinkerton C. A., King S. B., 3rd, Raizner A. E., Holmes D. R., Kereiakes D. J., Topol E. J. Major clinical events after coronary stenting. The multicenter registry of acute and elective Gianturco-Roubin stent placement. The Gianturco-Roubin Intracoronary Stent Investigator Group. Circulation. 1994 Mar;89(3):1126–1137. doi: 10.1161/01.cir.89.3.1126. [DOI] [PubMed] [Google Scholar]
  27. Versaci F., Gaspardone A., Tomai F., Crea F., Chiariello L., Gioffrè P. A. A comparison of coronary-artery stenting with angioplasty for isolated stenosis of the proximal left anterior descending coronary artery. N Engl J Med. 1997 Mar 20;336(12):817–822. doi: 10.1056/NEJM199703203361201. [DOI] [PubMed] [Google Scholar]

Articles from Heart are provided here courtesy of BMJ Publishing Group

RESOURCES