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Adapted from ref. 78

Procedural success was defined as angiographic success (stent deployed and <50% residual stenosis) with no in-hospital death, MI, or CABG surgery. Procedural success is recorded as the percentage of patients with angiographic success, since not all studies reported the procedural outcome of patients without angiographic success.

aAll early adverse events were assessed in-hospital except for the Schomig study, which assessed early adverse event within 4 wk.

b6-Mo follow-up data.

aIn 26 patients (8% with successful stent deployment) from the Schomig study, and 5 patients (7.8%) from the Wiktor European Stent study, stenting was performed prior to early nonemergency CABG surgery due to uncertainty regarding subacute thrombosis risk and the extent of myocardium at risk.

NR, not reported.

Adapted from ref. 78

Procedural success was defined as angiographic success (stent deployed and <50% residual stenosis) with no in-hospital death, MI, or CABG surgery. Procedural success is recorded as the percentage of patients with angiographic success, since not all studies reported the procedural outcome of patients without angiographic success.

aAll early adverse events were assessed in-hospital except for the Schomig study, which assessed early adverse event within 4 wk.

b6-Mo follow-up data.

aIn 26 patients (8% with successful stent deployment) from the Schomig study, and 5 patients (7.8%) from the Wiktor European Stent study, stenting was performed prior to early nonemergency CABG surgery due to uncertainty regarding subacute thrombosis risk and the extent of myocardium at risk.

NR, not reported.

intracoronary thrombolytic infusion (72) were effective at times, MI and/or death were frequent sequelae of acute vessel closure prior to the introduction of coronary stenting. Indeed, the 1985/1986 National Heart Lung and Blood Institute (NHLBI) registry showed that following acute vessel closure, 5% of patients died in hospital, 32% were sent for CABG surgery, and 42% sustained MI (73). Several small, randomized trials have shown stenting to be an effective "bail-out" technique in cases of post-PTCA acute vessel closure, which can be caused by coronary dissection, spasm, or thrombus (74-76). A pooled analysis of "bail-out" stenting in 1033 patients (25% presenting with acute vessel closure) reported a procedural success rate of 85.6%, a mortality rate of 2.4%, an emergency CABG rate of 8.2%, an acute MI rate of 6.9%, and a stent thrombosis rate of 8.5% (74-78) (Table 3). Given the apparent benefits from prior historical NHLBI data, a randomized trial testing the efficacy of "bail-out" stenting seems highly unlikely. The frequency of stent use as a "bail-out" technique has declined as primary stenting of "off label" indications has increased. However, it continues to be an accepted back-up measure for those lesions that are best managed initially by PTCA.

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