Background Published data suggest that lower socioeconomic status may adversely impact health outcomes in patients with coronary artery disease. Data regarding post-PCI outcomes are particularly limited in this population. We assessed event-free survival in public health system (PHS) patients undergoing single (SV) vs multivessel (MV) PCI with procedural glycoprotein (Gp) IIb/IIIa inhibition and long-term dual antiplatelet therapy with aspirin and clopidogrel.
Methods 280 consecutive patients (205 SV, 75 MV) undergoing PCI at Cook County Hospital, with uniform Medtronic AVE bare metal stent use, procedural Gp IIb/IIIa inhibition and intended long-term ASA/clopidogrel use were followed as a prospective cohort for occurrence of the composite MACE endpoint (death, MI, urgent TVR) and all-cause mortality. Clinical, demographic and procedural data were compiled and analyzed with missing angiographic data adjudicated by blinded review. Kaplan-Meier life table analyses were performed for the cohort, using the Wilcoxon and log-rank tests for survivor functions.
Results Demographic variables and risk factors were similar between SV and MV groups except smoking (80.6% vs 19.4%, p<0.031) and family history of CAD (37.3% vs 24.4%, p = 0.02). PCI indications were comparably distributed between SV and MV groups. Overall 46% of patients presented with ACS/NSTEMI or STEMI. Procedural GpIIb/IIIa inhibition was used in 98.3% of patients and 73.3% of patients were on aspirin plus clopidogrel at long-term follow-up. The groups were similar with regard to stents per vessel and stented length per vessel but differed by total stents per patient (1.05 vs 1.79, p<0.001). Clinical follow-up (mean 329, max 780 days) was attained in 93.9% of patients. Overall 1 year event-free survival was 91.4%. MACE-free survival by Kaplan Meier analysis was similar between SV and MV cohorts at a total follow-up of 780 days (92.2% vs 90.7%, p = 0.66).
Conclusions Single and multivessel PCI with bare-metal stent use, adjunctive GPIIb/IIIa inhibition and long-term clopidogrel therapy was associated with excellent event-free survival in the PHS population studied. Despite a sizeable subset of high-risk patients, these estimates are comparable to historical, non-PHS control populations undergoing bare metal stenting.
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