Outcomes of Oversized Coronary Stenting in Patients Undergoing Elective Percutaneous Coronary Intervention

Document Type : Original Article

Authors

Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

Abstract

Background: The size of the coronary stent has an important role in the efficacy of stenting and its complications. The present study focused on the clinical outcomes of undersized, normal-sized, and oversized stenting.
 
Methods: This historical cohort study, conducted from April 2016 to March 2017 at Rajaie Cardiovascular Medical and Research Center, analyzed the results of elective percutaneous coronary intervention (PCI) and angiography on patients who met the inclusion criteria. Based on the ratio between the stent and the reference vessel, the patients were divided into 3 groups: undersized stenting (stent diameter/reference vessel diameter <0.9), normal-sized stenting (ratio=0.9–1), and oversized stenting (ratio>1). Data on demographic characteristics, procedural characteristics, underlying diseases, the hospital length of stay, major adverse cardiac events (MACE), post- PCI restenosis, stent thrombosis, and post-PCI cerebrovascular accident were extracted from the patients’ files and entered into a checklist.
 
Results: Oversized stenting significantly reduced the incidence of MACE 1 year after PCI compared with undersized and normal-sized stenting. The incidence of rehospitalization for acute coronary syndrome was 7.5 times lower in oversized stenting than in undersized stenting (P=0.002). The incidence of re-PCI on the involved vessel decreased significantly with an increase in the stent size (P=0.017). Additionally, there was no incidence of stent restenosis in oversized stenting (P=0.001). The other outcomes had no significant correlation with the stent size.
 
Conclusions: Based on the results of our study, oversized stenting could improve clinical outcomes. (Iranian Heart Journal 2021; 22(2): 44-50)

Keywords


  1. Gaziano TA, Bitton A, Anand S, Abrahams-Gessel S, Murphy A. Growing epidemic of coronary heart disease in low-and middle-income countries. Current problems in cardiology. 2010 Feb 1;35(2):72-115. https://doi.org/10.1016/j.cpcardiol.2009.10.002 . PMID:201099792.
  2. Pepine CJ, Wolff AA, Ranolazine Study Group. A controlled trial with a novel anti-ischemic agent, ranolazine, in chronic stable angina pectoris that is responsive to conventional antianginal agents. The American journal of cardiology. 1999 Jul 1; 84(1):46-50. https://doi.org/10.1016/s0002-9149 (99)00190-3.PMID: 10404850
  3. Braunwald E, Morrow DA. Unstable angina: is it time for a requiem?. Circulation. 2013 Jun 18; 127(24):2452-7. https://doi.org/10.1161/CIRCULATIONAHA.113.001258 . PMID: 237751
  4. Martín JJ, Ruigómez AC, Varela CC, Vicente MN, Antolín JM, Calle PT, Abad CG. Indicaciones de revascularización: aspectos clínicos. Revista española de cardiología. 2005 Feb 1; 58(2):198-216. https://doi.org/10.1157/13071894.PMID: 15743566
  5. Fischman DL, Leon MB, Baim DS, Schatz RA, Savage MP, Penn I, Detre K, Veltri L, Ricci D, Nobuyoshi M, Cleman M. A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. New England Journal of Medicine. 1994 Aug 25; 331(8):496-501. DOI: 10.1056/NEJM199408253310802.PMID:8041414
  6. Serruys PW, De Jaegere P, Kiemeneij F, Macaya C, Rutsch W, Heyndrickx G, Emanuelsson H, Marco J, Legrand V, Materne P, Belardi J. A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. New England Journal of Medicine. 1994 Aug 25; 331(8):489-95. https://doi.org/10.1056/NEJM199408253310801. PMID: 8041413
  7. Omidi N, Kashani BS, Piranfar MA, Khorgami MR, Yekta BG, Omidi H. The correlation of diastolic dysfunction with TIMI frame count in patients with chronic stable angina pectoris. Tehran University Medical Journal. 2012 Dec 1; 70(9).
  8. Grines CL, Cox DA, Stone GW, Garcia E, Mattos LA, Giambartolomei A, Brodie BR, Madonna O, Eijgelshoven M, Lansky AJ, O'Neill WW. Coronary angioplasty with or without stent implantation for acute myocardial infarction. New England Journal of Medicine. 1999 Dec 23; 341(26):1949-56. DOI: 10.1056/NEJM199912233412601
  9. Endo M, Hibi K, Shimizu T, Komura N, Kusama I, Otsuka F, Mitsuhashi T, Iwahashi N, Okuda J, Tsukahara K, Kosuge M. Impact of ultrasound attenuation and plaque rupture as detected by intravascular ultrasound on the incidence of no-reflow phenomenon after percutaneous coronary intervention in ST-segment elevation myocardial infarction. JACC: Cardiovascular Interventions. 2010 May 1; 3(5):540-9. DOI: 10.1016/j.jcin.2010.01.015
  10. Ohshima K, Ikeda S, Kadota H, Yamane K, Izumi N, Ohshima K, Hamada M. Impact of culprit plaque volume and composition on myocardial microcirculation following primary angioplasty in patients with ST-segment elevation myocardial infarction: virtual histology intravascular ultrasound analysis. International journal of cardiology. 2013 Aug 10; 167(3):1000-5. https://doi.org/10.1016/j.ijcard.2012.03.079
  11. Hermiller JB, Fry ET, Peters T, Orr CM, Van Tassel J, Pinkerton CA. Quantitative and Qualitative Coronary Angiography. InVascular Diagnostics 1994 (pp. 267-275). Springer, Berlin, Heidelberg.https://doi.org/10.1002/ccd.1810250207. PMID: 1544153
  12. Tobin KJ. Stable angina pectoris: what does the current clinical evidence tell us?. Journal of the American Osteopathic Association. 2010 Jul 1; 110(7):364. PMID: 20693568
  13. Pursnani S, Korley F, Gopaul R, Kanade P, Chandra N, Shaw RE, Bangalore S. Percutaneous coronary intervention versus optimal medical therapy in stable coronary artery disease: a systematic review and meta-analysis of randomized clinical trials. Circulation: Cardiovascular Interventions. 2012 Aug; 5(4):476-90.https://doi.org/10.1161/CIRCINTERVENTIONS.112.970954
  14. Russo RJ, Silva PD, Yeager M. Coronary artery overexpansion increases neointimal hyperplasia after stent placement in a porcine model. Heart. 2007 Dec 1; 93(12):1609-15. https://doi.org/10.1136/hrt.2006.105981. PMID: 17639098
  15. Hosseini SK, Ansari MJ, Tokaldany ML, Sharafi A, Kazazi EH, Poorhosseini H. Association between preprocedural hemoglobin level and 1-year outcome of elective percutaneous coronary intervention. Journal of cardiovascular medicine. 2014 Apr 1; 15(4):331-5. https://doi.org/10.2459/JCM.0b013e32835ec938. PMID: 23422885
  16. De Benedetti E, Urban P. Coronary stenting: why size matters. Heart. 2007 Dec;93(12):1500.https://dx.doi.org/10.1136%2Fhrt.2006.113860. PMID: 18003677
  17. Kitahara H, Okada K, Kimura T, Yock PG, Lansky AJ, Popma JJ, Yeung AC, Fitzgerald PJ, Honda Y. Impact of stent size selection on acute and long-term outcomes after drug-eluting stent implantation in de novo coronary lesions. Circulation: Cardiovascular Interventions. 2017 Oct; 10(10):e004795. https://doi.org/10.1161/CIRCINTERVENTIONS.116.004795.