Copyright © 1999 by the European Society of Cardiology.
Stent implantation reduces restenosis in patients with suboptimal results following coronary angioplasty
a Department of Cardiology, Royal Brompton and Harefield NHS Trust, London, U.K.
b Division of Chemical Pathology, University of Leicester, Glenfield Hospital Trust, Leicester, U.K.
revised January 26, 1999; accepted February 3, 1999
Abstract
Background Primary intracoronary stenting reduces the rate of restenosis when compared with balloon angioplasty (PTCA) in selected patients. The strategy of PTCA followed by provisional stent placement for suboptimal PTCA results may be preferable to universal stenting but has not yet been tested in a randomized trial.
Methods An attempt was made to obtain an optimal result with PTCA alone in 143 patients. Stenting was required in 50 patients (35%) for significant coronary dissection or PTCA failure. In the remaining 93 patients, the angiographic result was assessed immediately using on-line quantitative coronary angiography and classified as either optimal (<15% residual stenosis) or suboptimal (
15% residual stenosis). Sixteen patients (11%) had an optimal result from PTCA. The remaining 77 (54%) patients had a suboptimal result and were immediately randomized either to no further treatment or to the placement of a stent. The primary end-point was the rate of restenosis (>50% stenosis), assessed by quantitative coronary angiography, at 6 months.
Results Angiographic follow-up was completed in 132 patients. Restenosis occurred in 53 (36,69)% of patients with a suboptimal result randomized to PTCA alone compared with 24 (12,41)% of patients randomized to stent (P=0·023). There was no significant difference in minimal luminal diameter at follow-up between the randomized groups. The rate of restenosis was 14 (2,43)% in patients with an optimal PTCA result and 14 (5,28)% in those that required stenting.
Conclusions Optimal angiographic results following conventional PTCA are rare and the restenosis rate following suboptimal results is high. The strategy of stenting suboptimal results is associated with a significant reduction in the rate of stenosis.
Key Words: Angioplasty, stent, restenosis
f1 Correspondence: Dr Charles Knight, Department of Cardiology, London Chest Hospital, Bonner Road, London E2 9JX, U.K.
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