Procedural results and late clinical outcomes after placement of three or more stents in single coronary lesions

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 (greater than or equal to 1 year) in a consecutive series of patients treated with multiple (greater than or equal to 3) contiguous stents in single lesions, we evaluated in-hospital and long-term (1-year) clinical outcomes in 117 consecutive patients treated with greater than or equal to 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 greater than or equal to 3 stents were used. Non-Q-wave MI (CK-MB greater than or equal to 5 times normal) was more frequent after greater than or equal to 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 greater than or equal to 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 greater than or equal to 3 stents, respectively), and overall cardiac event-free survival was similar during follow-up (P=.70). Conclusions-Patients treated with multiple (greater than or equal to 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.