Staged versus one-step approach for multivessel percutaneous coronary interventions

Eugenia Nikolsky, Majdi Halabi, Ariel Roguin, Alexander Zdorovyak, Luis Gruberg, Jamal Hir, Ehud Grenadier, Monther Boulos, Walter Markiewicz, Shai Linn, Rafael Beyar

Research output: Contribution to journalArticle

Abstract

Background: Percutaneous coronary interventions (PCIs) in patients with multivessel coronary artery disease (CAD) may be staged or performed in a single session. No data exist about the relative safety and efficacy of these 2 strategies. Our aim was to compare short-term and long-term outcomes of patients with multivessel CAD who underwent PCI in 1 versus 2 sessions. Methods and Results: The study included 264 consecutive patients who underwent treatment in our center during 1997 and 1998. PCI was conducted in a single session in 129 patients and was staged in 135 patients. The mean interval between the sessions in the staged group was 45.6 ± 22.3 days. The rates of major adverse cardiac events (MACEs) during in-hospital stay did not differ significantly between the staged (combined for both stages) and nonstaged groups (2.2% vs 4.6%; P = .28). A trend for lower event rates at 30-day (2.9% vs 6.9%; P = .13) and 1-year follow-up (26.1 vs 35.9; P = .08) favored the staged arm. Diameter stenosis ≥50% was found in 17% of patients in the staged group in the second session and was successfully retreated in most of them. No MACE occurred between the sessions. Multivariate analysis identified staging of the procedure as a single independent predictor of MACE at 1-year follow-up (P = .05). Conclusion: Our results suggest that a practical staging strategy within 4 to 8 weeks is safe and allows for identification and treatment of potential excessive proliferative response in the previously intervened lesions during the second procedure.

Original languageEnglish (US)
Pages (from-to)1017-1026
Number of pages10
JournalAmerican Heart Journal
Volume143
Issue number6
DOIs
StatePublished - 2002
Externally publishedYes

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Percutaneous Coronary Intervention
Coronary Artery Disease
Length of Stay
Pathologic Constriction
Multivariate Analysis
Safety
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Nikolsky, E., Halabi, M., Roguin, A., Zdorovyak, A., Gruberg, L., Hir, J., ... Beyar, R. (2002). Staged versus one-step approach for multivessel percutaneous coronary interventions. American Heart Journal, 143(6), 1017-1026. https://doi.org/10.1067/mhj.2002.1225007

Staged versus one-step approach for multivessel percutaneous coronary interventions. / Nikolsky, Eugenia; Halabi, Majdi; Roguin, Ariel; Zdorovyak, Alexander; Gruberg, Luis; Hir, Jamal; Grenadier, Ehud; Boulos, Monther; Markiewicz, Walter; Linn, Shai; Beyar, Rafael.

In: American Heart Journal, Vol. 143, No. 6, 2002, p. 1017-1026.

Research output: Contribution to journalArticle

Nikolsky, E, Halabi, M, Roguin, A, Zdorovyak, A, Gruberg, L, Hir, J, Grenadier, E, Boulos, M, Markiewicz, W, Linn, S & Beyar, R 2002, 'Staged versus one-step approach for multivessel percutaneous coronary interventions', American Heart Journal, vol. 143, no. 6, pp. 1017-1026. https://doi.org/10.1067/mhj.2002.1225007
Nikolsky, Eugenia ; Halabi, Majdi ; Roguin, Ariel ; Zdorovyak, Alexander ; Gruberg, Luis ; Hir, Jamal ; Grenadier, Ehud ; Boulos, Monther ; Markiewicz, Walter ; Linn, Shai ; Beyar, Rafael. / Staged versus one-step approach for multivessel percutaneous coronary interventions. In: American Heart Journal. 2002 ; Vol. 143, No. 6. pp. 1017-1026.
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AU - Nikolsky, Eugenia

AU - Halabi, Majdi

AU - Roguin, Ariel

AU - Zdorovyak, Alexander

AU - Gruberg, Luis

AU - Hir, Jamal

AU - Grenadier, Ehud

AU - Boulos, Monther

AU - Markiewicz, Walter

AU - Linn, Shai

AU - Beyar, Rafael

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AB - Background: Percutaneous coronary interventions (PCIs) in patients with multivessel coronary artery disease (CAD) may be staged or performed in a single session. No data exist about the relative safety and efficacy of these 2 strategies. Our aim was to compare short-term and long-term outcomes of patients with multivessel CAD who underwent PCI in 1 versus 2 sessions. Methods and Results: The study included 264 consecutive patients who underwent treatment in our center during 1997 and 1998. PCI was conducted in a single session in 129 patients and was staged in 135 patients. The mean interval between the sessions in the staged group was 45.6 ± 22.3 days. The rates of major adverse cardiac events (MACEs) during in-hospital stay did not differ significantly between the staged (combined for both stages) and nonstaged groups (2.2% vs 4.6%; P = .28). A trend for lower event rates at 30-day (2.9% vs 6.9%; P = .13) and 1-year follow-up (26.1 vs 35.9; P = .08) favored the staged arm. Diameter stenosis ≥50% was found in 17% of patients in the staged group in the second session and was successfully retreated in most of them. No MACE occurred between the sessions. Multivariate analysis identified staging of the procedure as a single independent predictor of MACE at 1-year follow-up (P = .05). Conclusion: Our results suggest that a practical staging strategy within 4 to 8 weeks is safe and allows for identification and treatment of potential excessive proliferative response in the previously intervened lesions during the second procedure.

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