Compared with stable clinical conditions,
unstable angina carries an increased risk of immediate and delayed cardiac adverse events after balloon coronary angioplasty. The influence of
stent use in reducing these differences remains unknown. We analyzed the early (30 days) and late outcome of a cohort of 459 consecutive patients who underwent
stent placement with
ticlopidine and
aspirin as antithrombotic regimen according to the presence (group 1, n = 151) or absence (group 2, n = 308) of
unstable angina at rest (Braunwald classes II and III). Group 1 patients were older and more likely to be current or former smokers. In group 2, prior
myocardial infarction was more frequent. Procedural, in-hospital results, and early outcome were similar in the 2 groups. However, over the long term, the incidence of
myocardial infarction (11% vs 6%, p <0.04), target lesion revascularization (19% vs 13%, p <0.04), or any revascularization (30% vs 20%, p <0.01) was significantly higher in group 1. Kaplan-Meier probabilities of survival without
myocardial infarction (85% vs 91%, p <0.05), survival without revascularization of the target lesion (73% vs 83%, p <0.01), survival without any revascularization (65% vs 77%, p <0.006), and survival without any events (61% vs 73%, p <0.009) were significantly worse in group 1. In addition, Cox multivariate analysis showed that
unstable angina at rest was an independent predictor of target lesion revascularization, of survival without any revascularization, and without any events. Thus,
unstable angina at rest remains an adverse prognostic
indicator in patients treated with intracoronary
stents, particularly with regard to subsequent requirement of revascularization procedures and event-free survival.