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Direct coronary stent implantation does not reduce the incidence of in-stent restenosis or major adverse cardiac events: six month results of a randomized trial.
| Content Provider | Semantic Scholar |
|---|---|
| Author | Ijsselmuiden, Alexander J. J. Serruys, Patrick Washington Scholte, Arthur J. H. A. Kiemeneij, Ferdinand Slagboom, Ton Wieken, L. R. Vd Tangelder, Geert W. J. M. Laarman, Gerrit Jan |
| Copyright Year | 2003 |
| Abstract | STUDY OBJECTIVE To compare the long-term angiographic, clinical and economic outcome of direct stenting vs stenting after balloon predilatation. PATIENT POPULATION AND METHODS Four hundred patients with coronary stenoses in a single native vessel were randomized to direct stenting vs stenting after predilatation. A major adverse cardiac and cerebral event (MACCE) was defined as death, myocardial infarction, stent thrombosis, target restenosis, repeat target- and non-target vessel-related percutaneous coronary intervention, target lesion revascularization, coronary artery bypass surgery and stroke. RESULTS Stents were successfully implanted in 98.3% of patients randomized to direct stenting vs 97.8% randomized to stenting preceded by predilatation. The primary success rate of direct stenting was 88.3%, vs 97.8% for stenting preceded by balloon dilatation (P=0.01). The angiographic follow-up at 6 months included 333 of the 400 patients (83%). The binary in-stent restenosis rate was 23.1% of 163 patients randomized to direct stenting vs 18.8% of 166 patients randomized to balloon predilatation (P=0.32). By 185+/-25 days, MACCE had occurred in 31 of 200 (15.5%) patients randomized to direct stenting, vs 33 of 200 (16.5%) randomized to predilatation (P=0.89). At 6 months, costs associated with the direct stenting strategy (Euros 3222/patient) were similar to those associated with predilatation (Euros 3428/patient, P=0.43). However, procedural costs were significantly lower. It is noteworthy that, on multivariate analysis, a baseline C-reactive protein level >10 mg l(-1)was a predictor of restenosis (odds ratio: 2.10, P=0.025) as well as of MACCE (odds ratio: 1.94, P=0.045). CONCLUSIONS Compared to stenting preceded by balloon predilatation, direct stenting was associated with similar 6-month restenosis and MACCE rates. Procedural, but not overall 6-month costs, were reduced by direct stenting. An increased baseline CRP level was an independent predictor of adverse long-term outcome after coronary stent implantation. |
| Starting Page | 212 |
| Ending Page | 219 |
| Page Count | 8 |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | http://www.summitmd.com/pdf/syllabus/2004/stent_restenosis.pdf |
| PubMed reference number | 12633544v1 |
| Volume Number | 24 |
| Issue Number | 5 |
| Journal | European heart journal |
| Language | English |
| Access Restriction | Open |
| Subject Keyword | Artificial cardiac pacemaker Balloon Dilatation Blood Vessel Tissue Cerebrovascular accident Cessation of life Coronary Artery Bypass Surgery Coronary Stenosis Dilate procedure Implants Myocardial Infarction Patients Percutaneous Coronary Intervention STENT, CORONARY Stent Device Component Stent, device Thrombosis restenosis revascularization |
| Content Type | Text |
| Resource Type | Article |
