Author + information
- Received April 18, 1996
- Revision received July 5, 1996
- Accepted July 12, 1996
- Published online November 15, 1996.
- Per Anton Sirnes, MD∗∗ (, )
- Svein Gold, MD, PhD∗,
- Yngvar Myreng, MD, PhD∗,
- Per Mølstad, MD, PhD∗,
- Håkean Emanuelsson, MD, PhD∗,
- Per Albertsson, MD, PhD∗,
- Magne Brekke, MD†,
- Arild Mangschau, MD, PhD†,
- Knut Endresen, MD, PhD‡,d and
- John Kjekshus, MD, PhD‡
- ↵∗Address for correspondence: Dr. Per Anton Sirnes, Feiring Heart Clinic, N-2093 Feiring, Norway
Objectives. This study investigated whether stenting improves long-term results after recanalization of chronic coronary occlusions.
Background. Restenosis is common after percutaneous transluminal coronary angioplasty (PTCA) of chronic coronary occlusions. Stenting has been suggested as a means of improving results, but its use has not previously been investigated in a randomized trial.
Methods. We randomly assigned 119 patients with a satisfactory result after successful recanalization by PTCA of a chronic coronary occlusion to 1) a control (PTCA) group with no other intervention, or 2) a group in which PTCA was followed by implantation of Palmaz-Schatz stents with full anticoagulation. Coronary angiography was performed before randomization, after stenting and at 6-month follow-up.
Results. Inguinal bleeding was more frequent in the stent group. There were no deaths. One patient with stenting had a myocardial infarction. Subacute occlusion within 2 weeks occurred in four patients in the stent group and in three in the PTCA group. At follow-up, 57% of patients with stenting were free from angina compared with 24% of patients with PTCA only (p < 0.001). Angiographic follow-up data were available in 114 patients. Restenosis (≥50% diameter stenosis) developed in 32% of patients with stenting and in 74% of patients with PTCA only (p < 0.001); reocclusion occurred in 12% and 26%, respectively (p = 0.058). Minimal lumen diameter (mean ± SD) at follow-up was 1.92 ± 0.95 mm and 1.11 ± 0.78 mm, respectively (p < 0.001). Target lesion revascularization within 300 days was less frequent in patients with stenting than in patients with PTCA only (22% vs. 42%, p = 0.025).
Conclusions. Stent implantation improved long-term angiographic and clinical results after PTCA of chronic coronary occlusions and is thus recommended regardless of the primary PTCA result.
☆ This study was supported in part by grants from Johnson & Johnson Interventional System, Warren, New Jersey and from the Feiring Heart Research Foundation, Feiring, Norway.
- Received April 18, 1996.
- Revision received July 5, 1996.
- Accepted July 12, 1996.