Document Detail

Angiographic analysis of immediate and long-term results of PTCR vs. PTCA in complex lesions (COBRA study).
MedLine Citation:
PMID:  11458414     Owner:  NLM     Status:  MEDLINE    
We conducted a prospective, randomized trial to compare immediate and long-term effects of percutaneous transluminal coronary angioplasty (PTCA) and high-frequency rotational atherectomy (PTCR) in patients with angiographically predefined complex coronary artery lesions (AHA type B2 and C). The relation of lesion characteristics to procedural results is reported in this angiographic analysis. Patients were randomly assigned to balloon angioplasty (n = 250 patients) or rotational atherectomy (n = 252 patients). Quantitative coronary angiography could be performed in 447 patients to evaluate immediate results and in 293 patients with a 6-month angiographic follow-up. Procedural success was comparable in the PTCR and in the PTCA group (80% vs. 76%, P = 0.260). The need for stent implantation due to a residual stenosis >50% or a bail-out situation was significantly higher in the PTCA group (9.7% vs. 2.0%, P = 0.001). In both treatment groups, diameter stenosis was effectively reduced and MLD increased. The acute gain did not differ between the two groups. At 6-month control, the restenosis rate was comparable in the PTCR and in the PTCA group (37% vs. 35%, P = 0.658), whereas diameter stenosis was significantly more severe in the PTCR group than in the PTCA group (52% vs. 46%, P = 0.039) and, correspondingly, the MLD was significantly smaller in the PTCR group (1.29 mm vs. 1.44 mm, P = 0.031). Late loss was about the same in both groups, however, net gain and net gain index were significantly higher in the PTCA group (0.82 mm vs. 0.64 mm, P = 0.008; and 31% vs. 24%, P = 0.009). Analysis of procedural results for various lesion characteristics revealed no significant difference between treatment groups. In this randomized trial, complex coronary artery lesions were treated with comparable results for angiographic and procedural success and the restenosis rate by both, PTCA and PTCR. Late loss, however, was significantly higher and net gain significantly smaller after PTCR. Stents, although infrequently used, had a relevant impact on immediate PTCA results but not on late results. Cathet Cardiovasc Intervent 2001;53:359-367.
U Dietz; H J Rupprecht; O Ekinci; T Dill; R Erbel; K H Kuck; R Abdollahnia; G Rippin; J Meyer; C Hamm
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial    
Journal Detail:
Title:  Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions     Volume:  53     ISSN:  1522-1946     ISO Abbreviation:  Catheter Cardiovasc Interv     Publication Date:  2001 Jul 
Date Detail:
Created Date:  2001-07-17     Completed Date:  2001-09-20     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  359-67     Citation Subset:  IM    
Copyright Information:
Copyright 2001 Wiley-Liss, Inc.
University Hospital Mainz, Mainz, Germany.
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MeSH Terms
Angioplasty, Transluminal, Percutaneous Coronary*
Atherectomy, Coronary*
Coronary Angiography*
Coronary Disease / radiography,  therapy*
Coronary Vessels / surgery
Graft Occlusion, Vascular / radiography
Middle Aged
Prospective Studies
Time Factors
Treatment Outcome
Comment In:
Catheter Cardiovasc Interv. 2001 Jul;53(3):368   [PMID:  11458415 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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