CLINICAL OUTCOMES OF PATIENTS MORE THAN ONE-YEAR FOLLOWING RANDOMIZATION IN THE CANADIAN-CORONARY-ATHERECTOMY-TRIAL (CCAT)

BACKGROUND: The Canadian Coronary Atherectomy Trial (CCAT) assessed, i n a randomized comparison, the clinical and angiographic outcomes foll owing atherectomy with those following balloon angioplasty for the tre atment of de novo Lesions in the proximal one-third of the left anteri or descending artery (LAD). Although the procedural success rate was s omewhat higher and the postprocedure lumen larger in patients treated with atherectomy, lumen dimensions, restenosis rates and clinical outc omes were similar in the two groups at six months. To determine whethe r late differences emerged between the groups, clinical follow-up was obtained at a median of 18 (range 10 to 31) months after randomization . METHODS AND RESULTS: Patients were contacted monthly by telephone fo r the first six months. Subsequent follow-up information was obtained in 272 (99%) of the 274 randomized patients via a clinic visit or tele phone interview with the patient and/or a relative. Additional informa tion was obtained from the referring physician as required. There were no differences in adverse events between the two groups during follow -up. In patients randomized to atherectomy compared with balloon angio plasty, death occurred in 1.5% versus 2.2% (cardiac death 0.7% versus 0.7%); myocardial infarction in 5.1% versus 5.9% (Q wave 1.5% versus 1 .5%); coronary bypass surgery in 13.1% versus 12.6%; and repeat target Lesion intervention in 22.6% versus 21.5%. Persistent or recurrent Ca nadian Cardiovascular Society class III/IV angina not treated by a fur ther intervention was present in 1.5% versus 2.2%. The combined end-po int of death or nonfatal myocardial infarction occurred in nine (6.6%) versus 11 (8.1%) patients and any adverse cardiac event in 50 (36.5%) versus 53 (39.3%). Multivariate logistic regression indicated that un stable angina, reference vessel size and preprocedure minimum lumen di ameter were the only variables independently associated with adverse e vents. CONCLUSIONS: The initial choice of directional atherectomy or b alloon angioplasty had no impact on clinical outcome over a period of 18 months in this patient population. With either technique, just over 60% of patients with proximal LAD disease experienced sustained sympt omatic improvement without an adverse event following a single procedu re, and 80% achieved this status following a repeat percutaneous inter vention.