H. Mudra et al., Randomized comparison of coronary stent implantation under ultrasound or angiographic guidance to reduce stent restenosis (OPTICUS study), CIRCULATION, 104(12), 2001, pp. 1343-1349
Citations number
26
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Background-Observational studies in selected patients have shown remarkably
low restenosis rates after ultrasound-guided stent implantation. However,
it is unknown whether this implantation strategy improves long-term angiogr
aphic and clinical outcome in routine clinical practice.
Methods and Results-A total of 550 patients with a symptomatic coronary les
ion or silent ischemia were randomly assigned to either ultrasound-guided o
r angiography-guided implantation of less than or equal to2 tubular stents.
The primary end points were angiographic dichotomous restenosis rate, mini
mal lumen diameter, and percent diameter stenosis after 6 months as determi
ned by quantitative coronary angiography. Secondary end points were the occ
urrence rates of major adverse cardiac events (death, myocardial infarction
, coronary bypass surgery, and repeat percutaneous intervention) after 6 an
d 12 months of follow-up. At 6 months, repeat angiography revealed no signi
ficant differences between the groups with ultrasound- or angiography-guide
d stent implantation with respect to dichotomous restenosis rate (24.5% ver
sus 22.8%, P=0.68), minimal lumen diameter (1.95 +/-0.72 mm versus 1.91 +/-
0.68 mm, P=0.52), and percent diameter stenosis (34.8 +/- 20.6% versus 36.8
+/- 19.6%, P=0.29), respectively. At 12 months, neither major adverse card
iac events (relative risk, 1.07; 95% CI 0.75 to 1.52; P=0.71) nor repeat pe
rcutaneous interventions (relative risk 1.04; 95% CI 0.64 to 1.67; P=0.87)
were reduced in the ultrasound-guided group.
Conclusions-This study does not support the routine use of ultrasound guida
nce for coronary stenting. Angiography-guided optimization of tubular stent
s can be performed with comparable angiographic and clinical long-term resu
lts.