Stent implantation versus balloon angioplasty in chronic coronary occlusions: Results from the GISSOC trial
Stent implantation versus balloon angioplasty in chronic coronary occlusions: Results from the GISSOC trial
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DOI：
10.1016/s0735-1097(98)00193-4
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发表时间：
1998-07-01
影响因子：
24
通讯作者：
Tommasini, G
中科院分区：
文献类型：
--
作者：
Rubartelli, P;Niccoli, L;Tommasini, G
目标.在这项多中心随机试验中，我们评估了慢性冠状动脉闭塞成功再通后支架植入术是否降低了再狭窄的发生率。经皮冠状动脉腔内成形术（PTCA）治疗慢性完全闭塞与血管造影再狭窄和再闭塞的发生率高于次全狭窄的PTCA。初步报道表明冠状动脉完全闭塞支架植入后再狭窄率降低。我们将110名完全闭塞再通的患者随机分配接受Palmaz-Schatz支架植入术，随后接受1个月的抗凝治疗，而不接受其他治疗。主要终点是随访时治疗节段的最小管腔直径（MLD），由中心实验室的定量血管造影确定。88%的患者在术后9个月进行了重复冠状动脉造影。随访时，分配至支架植入术的患者的MLD（平均值+/- SD）为1.74 +/- 0.88 mm，分配至PICA的患者为0.85 +/- .75 mm（p < 0.001）。支架植入术与较低的再狭窄发生率相关（定义为随访时直径狭窄大于或等于50%）（32% vs. 68%，p < 0.001）和再闭塞（8% vs. 34%，p = 0.003），同样，支架治疗患者的复发性缺血较少（14% vs. 46%，p = 0.002）和靶病变血运重建（5.3% vs. 22%，p = 0.038），但住院时间较长。在慢性完全闭塞的球囊PICA成功后植入Palmaz-Schatz支架可改善中期血管造影和临床结局，可能是选定闭塞血管患者的首选治疗选择。(C)1998年，美国心脏病学会。
Objectives. In this multicenter, randomized trial we evaluated whether stent implantation after successful recanalization of a chronic coronary occlusion reduced the incidence of restenosis.Background. Percutaneous transluminal coronary angioplasty (PTCA) in chronic total occlusions is associated with a higher rate of angiographic restenosis and reocclusion than PTCA in subtotal stenoses. Preliminary reports have suggested a decreased restenosis rate after stent implantation in coronary total occlusions.Methods. We randomly assigned 110 patients with recanalized total occlusion to Palmaz-Schatz stent implantation, followed by 1 month of anticoagulant therapy versus no other treatment. The primary end point was the minimal lumen diameter (MLD) of the treated segment at follow-up, as determined by quantitative angiography at a core laboratory.Results. Repeat coronary angiography was performed 9 months after the procedure in 88% of patients. The MLD (mean +/- SD) at follow-up was 1.74 +/- 0.88 mm in patients assigned to stent implantation and 0.85 +/- .75 mm in patients assigned to PICA (p < 0.001). Stent implantation was associated with a lower incidence of restenosis (defined as diameter stenosis greater than or equal to 50% at follow-up) (32% vs. 68%, p < 0.001) and reocclusion (8% vs. 34%, p = 0.003) than balloon PICA, Likewise, stent treated patients had less recurrent ischemia (14% vs. 46%, p = 0.002) and target lesion revascularization (5.3% vs. 22%, p = 0.038), but experienced a longer hospital stay.Conclusions. Palmaz-Schatz stent implantation after successful balloon PICA of chronic total occlusions improves the midterm angiographic and clinical outcome and could be the preferred treatment option in selected patients with occluded vessels. (C) 1998 by the American College of Cardiology.