A Comparison of Clinical Outcomes and Risks for Major Adverse Cardiac Events between the Pre- and Post-Stent Period

Kim, Byoung Keuk; Choi, Dong Hoon; Kim, Dong Ki; Kim, Hyun Jin; Jang, Yangsoo; Shim, Won Heum; Cho, Seung Yun

Abstract

BACKGROUND AND OBJECTIVES
everal studies have demonstrated improved outcomes achieved with stents vice balloon angioplasty. The purpose of this study was to compare the clinical outcomes and risk factors for major adverse cardiac events (MACE) between the pre- and post-stent period.
SUBJECTS AND METHODS
linical outcomes for 294 patients who had undergone balloon angioplasty alone in 1991 and 1992, were compared with those for of 320 patients who underwent stent implantation in 1998. The duration of follow-up was 12 months.
RESULTS
here were more patients with diabetes and hyperlipidemia in the stent group (p<0.05). The stent group had significantly more 3-vessel diseases and complex lesion morphology (p<0.05). Cardiac event-free survival rates in the stent group at 1, 6, and 12 months were significantly higher than those in the balloon group (1, 6, 12 month:7.0 vs 93.9%, 89.6 vs 82.3%, 83.7 vs 77.2%, p=0.03). MACE rates were highly associated with lesion morphology (OR=2.6, 95% CI 1.4-4.9) and angiotensin converting enzyme (ACE) inhibitors (OR=2.4, 95% CI 1.3-5.4) in the balloon group, and hypertension in the stent group (OR=2.7, 95% CI 1.3-5.6). Excluding acute myocardial infarction in the stent group, risk factors included diabetes (OR=4.8, 95% CI 1.6-14.2) and hypertension (OR=4.4, 95% CI 1.2-15.7). The stent group had significantly higher event-free survival rates in the complex lesions (p=0.002), but showed no difference in simple lesions.
CONCLUSION
ompared with balloon angioplasty in the early 1990s, stent implantation in 1998 was associated with higher early and late cardiac event-free survival rates. Risk factors included complex lesion morphology and the use of ACE inhibitors in balloon angioplasty, and hypertension and diabetes in the stent group.