Document Detail


Angiographic and clinical outcomes of drug-eluting versus bare metal stent deployment in the Occluded Artery Trial.
MedLine Citation:
PMID:  19309733     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
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.
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).
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.
Authors:
Vladimír Dzavík; Christopher E Buller; Gerard Devlin; Ronald G Carere; G B John Mancini; Warren J Cantor; Pawel E Buszman; James M Rankin; Carlos Vozzi; John R Ross; Sandra Forman; Bruce A Barton; A Gervasio A Lamas; Judith S Hochman
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions     Volume:  73     ISSN:  1522-726X     ISO Abbreviation:  Catheter Cardiovasc Interv     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-04-22     Completed Date:  2009-06-04     Revised Date:  2014-09-24    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  771-9     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Angina Pectoris / etiology
Angioplasty, Balloon, Coronary / adverse effects*,  instrumentation*,  mortality
Canada
Coronary Angiography*
Coronary Occlusion / mortality,  physiopathology,  radiography,  therapy*
Coronary Restenosis / etiology*,  mortality,  physiopathology,  radiography
Drug-Eluting Stents*
Female
Heart Failure / etiology
Humans
Kaplan-Meier Estimate
Logistic Models
Male
Metals*
Middle Aged
Myocardial Infarction / etiology
Platelet Aggregation Inhibitors / therapeutic use
Prospective Studies
Prosthesis Design
Risk Assessment
Stents*
Stroke Volume
Time Factors
Treatment Outcome
Ventricular Function, Left
Grant Support
ID/Acronym/Agency:
HL67683-01A1/HL/NHLBI NIH HHS; U01 HL062257/HL/NHLBI NIH HHS; U01 HL062509/HL/NHLBI NIH HHS; U01 HL062509/HL/NHLBI NIH HHS; U01 HL062509-01A1/HL/NHLBI NIH HHS; U01 HL062509-02/HL/NHLBI NIH HHS; U01 HL062509-03/HL/NHLBI NIH HHS; U01 HL062509-04/HL/NHLBI NIH HHS; U01 HL062509-05/HL/NHLBI NIH HHS; U01 HL062509-05S1/HL/NHLBI NIH HHS; U01 HL062509-06A1/HL/NHLBI NIH HHS; U01 HL062509-07/HL/NHLBI NIH HHS; U01 HL062509-08/HL/NHLBI NIH HHS; U01HL062511/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Metals; 0/Platelet Aggregation Inhibitors
Comments/Corrections
Comment In:
Catheter Cardiovasc Interv. 2009 May 1;73(6):780   [PMID:  19370758 ]

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


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