Stent implantation reduces restenosis in patients with suboptimal results following coronary angioplasty

Background Primary intracoronary stenting reduces the rate of restenosis wh en compared with balloon angioplasty (PTCA) in selected patients. The strat egy of PTCA followed by provisional stent placement for suboptimal PTCA res ults 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 co ronary dissection or PTCA failure. In the remaining 93 patients, the angiog raphic result was assessed immediately using on-line quantitative coronary angiography and classified as either optimal (<15% residual stenosis) or su boptimal (greater than or equal to 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 t reatment or to the placement of a stent. The primary end-point was the rate of restenosis (>50% stenosis), assessed by quantitative coronary angiograp hy, at 6 months. Results Angiographic follow-up was completed in 132 patients. Restenosis oc curred in 53 (36,69)% of patients with a suboptimal result randomized to PT CA alone compared with 24 (12,41)% of patients randomized to stent (P=0.023 ). There was no significant difference in minimal luminal diameter at follo w-up between the randomized groups. The rate of restenosis was 14 (2,43)% i n patients with an optimal PTCA result and 14 (5,28)% in those that require d stenting. Conclusions Optimal angiographic results following conventional PTCA are ra re and the restenosis rate following suboptimal results is high. The strate gy of stenting suboptimal results is associated with a significant reductio n in the rate of stenosis. (Eur Heart J 1999; 20: 1783-1790) (C) 1999 Europ ean Society of Cardiology.