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  • Title: Comparison of clinical outcome after elective and "bail out" coronary stent insertion.
    Author: Robinson NM, Thomas MR, Jewitt DE, Wainwright RJ.
    Journal: J Invasive Cardiol; 1995; 7(6):156-64. PubMed ID: 10155100.
    Abstract:
    BACKGROUND: Coronary stents may be used electively during percutaneous transluminal coronary angioplasty (PTCA) or as a "bail-out" device to treat abrupt or threatened vessel closure following PTCA. OBJECTIVE: To compare the clinical outcome of elective and "bail-out" coronary stent insertion. DESIGN: A retrospective analysis of all patients receiving coronary stents. SETTING: Tertiary referral center performing over 400 PTCA procedures a year. PATIENTS: Fifty-six patients (42 male), mean age 57 (range = 32 to 78) years received 67 Palmaz-Schatz coronary stents. Forty-nine stents were deployed as "bail-out" in 41 patients (abrupt vessel closure in 15 and threatened vessel closure in 26) and 18 stents were deployed electively in 15 patients. MAIN OUTCOME MEASURES: Myocardial infarction, repeat angiography, coronary artery bypass graft surgery and death. RESULTS: Stents were successfully deployed in 56/62 (90.3%) patients. In-hospital events were significantly more common in the "bail-out" group compared to the elective group. The in-hospital events, comparing the "bail-out" group versus the elective group, were as follows: Death 2/41 (4.9%) vs 0/15 (0%), coronary artery bypass graft surgery (CABG) 8/41 (19.5%) vs 0/15 (0%), stent thrombosis 3/41 (7.3%) vs 0/15 (0%), and myocardial infarction 6/41 (14.6%) vs 1/15 (6.7%) respectively. After discharge no patient died or had CABG. One patient in the "bail-out" group had a myocardial infarct (late stent thrombosis). Two patients from each group had repeat angiography because of recurrent angina in the 6 month follow up period. CONCLUSION: "Bail-out" stenting has an increased incidence of in-hospital complications compared to elective procedures. If these short-term problems can be overcome however, the clinical events in the first 6 months after leaving hospital are low and similar to patients under-going elective procedures.
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