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Angiographic and clinical outcomes of drug-eluting versus bare metal stent deployment in the Occluded Artery Trial.
- Source :
-
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions [Catheter Cardiovasc Interv] 2009 May 01; Vol. 73 (6), pp. 771-9. - Publication Year :
- 2009
-
Abstract
- Background: The majority of patients randomized to percutaneous coronary intervention (PCI) in the Occluded Artery Trial (OAT) and its angiographic substudy, the Total Occlusion Study of Canada 2 (TOSCA-2) were treated with bare metal stents (BMS). We aimed to determine if stenting of the target occlusion in OAT with drug-eluting stents (DES) was associated with more favorable angiographic results and clinical outcome when compared with treatment with BMS.<br />Methods: TOSCA-2 DES was a prospective nonrandomized substudy that provided 1-year angiographic comparison of late loss and reocclusion in 25 patients treated with DES and in 128 treated with BMS. In addition, all PCI-assigned patients enrolled from the time when DES were first utilized were similarly categorized (DES n = 77, and BMS n = 386) and compared using the 3-year cumulative OAT primary combined endpoint of death, myocardial infarction, or Class-IV heart failure, as well as angina.<br />Results: In-segment late loss was 0.14 +/- 0.45 mm for DES and 0.75 +/- 0.86 mm for BMS (P < 0.001). Corresponding binary restenosis rates were 13.0% and 44.3% (P = 0.005). Occlusion at 1 year was observed in 4.0 and 12.1%, respectively (P = 0.23). The 3-year cumulative primary event rate was 13.8% with DES and 12.5% with BMS (hazard ratio 1.08, 99% confidence intervals 0.44, 2.64; P = 0.83). Angina over time occurred less frequently in the DES group (P = 0.01).<br />Conclusions: Although the reduction of late loss and trend to reduction in reocclusion with the use of DES for PCI of persistently occluded IRA 3-28 days post myocardial infarction did not translate into a signal for reduction in death, reinfarction, or Class IV heart failure, DES use was associated with less angina over time. Further follow-up is warranted.
- Subjects :
- Adult
Aged
Angina Pectoris etiology
Angioplasty, Balloon, Coronary mortality
Canada
Coronary Occlusion diagnostic imaging
Coronary Occlusion mortality
Coronary Occlusion physiopathology
Coronary Restenosis diagnostic imaging
Coronary Restenosis mortality
Coronary Restenosis physiopathology
Female
Heart Failure etiology
Humans
Kaplan-Meier Estimate
Logistic Models
Male
Middle Aged
Myocardial Infarction etiology
Platelet Aggregation Inhibitors therapeutic use
Prospective Studies
Prosthesis Design
Risk Assessment
Stroke Volume
Time Factors
Treatment Outcome
Ventricular Function, Left
Angioplasty, Balloon, Coronary adverse effects
Angioplasty, Balloon, Coronary instrumentation
Coronary Angiography
Coronary Occlusion therapy
Coronary Restenosis etiology
Drug-Eluting Stents
Metals
Stents
Subjects
Details
- Language :
- English
- ISSN :
- 1522-726X
- Volume :
- 73
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
- Publication Type :
- Academic Journal
- Accession number :
- 19309733
- Full Text :
- https://doi.org/10.1002/ccd.21930