Coronary-Artery Stenting Compared with Balloon Angioplasty for Restenosis After Initial Balloon Angioplasty

Erbel, Raimund; Haude, Michael; Höpp, Hans W.; Franzen, D.; Rupprecht, Hans J.; Heublein, B; Fischer, Karsten; Jaegere, Peter de; Serruys, Patrick W.; Rutsch, Wolfgang; Probst, Peter

doi:10.1097/00132586-199908000-00007

Cited by 71 publications

(41 citation statements)

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“…Coronary stents have been shown to be superior in terms of better hospital results with a lower incidence of new major coronary events, offering the lowest residual diameter stenosis ever obtained in interventional cardiology and promoting a positive and quantitative influence toward lower restenosis and new target vessel revascularization rates. This outcome was observed in vein grafts (SAVED) 11 , restenotic lesions (REST) 12 , chronic occlusions (SICCO 13 and GISSOC 14 ) and in the first twenty-four hours of AMI (Zwole 15 , FRESCO 16 and PAMI Stent [17][18][19] ).…”

Section: Discussionmentioning

confidence: 99%

“…The results from a consecutive series of patients like ours and randomized trials confirm the superiority of stents to balloon PTCA, both in the hospital and late followup outcomes. In the presence of some high-risk subgroups of patients, such as those with diabetes [20][21] , unstable angina 7 , acute myocardial infarction [15][16][17][18][19] , vessels with reference size <3.0mm 7 , balloon PTCA failures 6 , lesions located in he proximal left anterior descending artery 7,22 , chronic occlusions [13][14] , vein grafts 11 , restenotic lesions 12 and multivessel coronary disease 23 , who undergo percutaneous coronary revascularization, stents will promote better results and should be the technique of first choice.…”

Section: Discussionmentioning

confidence: 99%

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Safety and efficacy of coronary stent implantation. Acute and six month outcomes of 1,126 consecutive patients treated in 1996 and 1997

Mattos¹,

Pinto²,

Abizaid³

et al. 1999

Arq. Bras. Cardiol.

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Original ArticlePurpose -The authors analyzed the 30-day and 6-month outcomes of 1,126 consecutive patients who underwent coronary stent implantation in 1996 and 1997. MI (1.3% vs 1.1%, 1996 vs 1997, emergency coronary bypass surgery (1% vs 0.6%, 1996(1% vs 0.6%, vs 1997 and 30-day death rates (0.2% vs 0.5%, 199630-day death rates (0.2% vs 0.5%, vs 1997 were similar. The 6-month restenosis rate was 25% in 1996 and 27% in 1997 (p= NS); the target vessel revascularization rate was 15% in 1996 and 16% in 1997 (p = NS). In the first years of its usage, randomized trials and many consecutive series of patients showed higher rates of thrombotic occlusion after coronary stent implantation (5 to 20%). This adverse event stimulated the use of one of the most severe antithrombotic drug regimens ever applied in interventional cardiology in an attempt to reduce the incidence of this major coronary complication. However, the series of procedures that followed this pharmacological approach did not demonstrate a reduction in the subacute occlusion rates, and major bleeding, a serious side effect, occurred. It is natural to conclude that this approach resulted in longer hospital stays with increasing costs, making physicians leery of recommending this new percutaneous coronary revascularization method 2-3 . Methods -The 30-day results and 6-month angiographic follow-up were analyzed in patients treated with coronary stents in 1996 and 1997. All patients underwent coronary stenting with high-pressure implantation (>12 atm) and antiplatelet drug regimen (aspirin plus ticlopidine). Results ConclusionsThe scenario changed, however, with the publication of the results of two major randomized studies in 1994, which compare balloon PTCA with stents. The comparison demonstrates that, stents can create significancy higher coronary lumen diameters, reduce the restenosis rate at the end of the first 6 months and as a consequence the need for further revascularization procedures, percutaneous or surgical, compared with the standard balloon PTCA method [4][5][6][7] . In 1995, Colombo et al 8 demonstrated that intravascular ultrasound could optimize stent delivery and implantation, applying higher balloon pressures (>12 ATM), promoting better stent symmetry, with a nearly full

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of coronary stent implantation. Acute and six month outcomes of 1,126 consecutive patients treated in 1996 and 1997

Mattos¹,

Pinto²,

Abizaid³

et al. 1999

Arq. Bras. Cardiol.

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“…Ten studies [36][37][38]42,44,46,50,56,57,76 included patients with single-vessel disease. Two studies 51,55 included patients who had lesions in SVGs.…”

Section: Adjunctive Treatmentmentioning

confidence: 99%

Coronary artery stents: a rapid systematic review and economic evaluation

Hill¹,

Bagust²,

Bakhai³

et al. 2004

Health Technol Assess

144

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Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per monograph and for the rest of the world £3 per monograph.You can order HTA monographs from our Despatch Agents:-fax (with credit card or official purchase order) -post (with credit card or official purchase order or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you either to pay securely by credit card or to print out your order and then post or fax it. NHS libraries can subscribe free of charge. Public libraries can subscribe at a very reduced cost of £100 for each volume (normally comprising 30-40 titles). The commercial subscription rate is £300 per volume. Please see our website for details. Subscriptions can only be purchased for the current or forthcoming volume. Contact details are as follows: Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to Direct Mail Works Ltd and drawn on a bank with a UK address. Paying by credit cardThe following cards are accepted by phone, fax, post or via the website ordering pages: Delta, Eurocard, Mastercard, Solo, Switch and Visa. We advise against sending credit card details in a plain email. Paying by official purchase orderYou can post or fax these, but they must be from public bodies (i.e. NHS or universities) within the UK. We cannot at present accept purchase orders from commercial companies or from outside the UK. How do I get a copy of HTA on CD?Please use the form on the HTA website (www.hta.ac.uk/htacd.htm). Or contact Direct Mail Works (see contact details above) by email, post, fax or phone. HTA on CD is currently free of charge worldwide.The website also provides information about the HTA Programme and lists the membership of the various committees. HTA NHS R&D HTA ProgrammeT he research findings from the NHS R&D Health Technology Assessment (HTA) Programme directly influence key decision-making bodies such as the National Institute for Clinical Excellence (NICE) and the National Screening Committee (NSC) who rely on HTA outputs to help raise standards of care. HTA findings also help to improve the quality of the service in the NHS indirectly in that they form a key component of the 'National Knowledge Service' that is being developed to improve the evidence of clinical practice throughout the NHS.The HTA Programme was set up in 1993. Its role is to ensure that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined to include all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care, rather than settings of care.The HTA programme commissions research only on topics where it has identified key gaps in the evidence needed by the NHS. Suggestions for topics are actively sought from people working in the NHS, the public...

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“…8 When interpreting the results from past studies, 9,10 it is important to realize that the introduction of intracoronary stents and the routine use of arterial conduits for bypass surgery have resulted in a remarkable improvement in outcomes after both percutaneous and surgical revascularization. 6,[11][12][13][14][15][16][17] The Arterial Revascularization Therapy Study (ARTS) was designed to compare CABG and stenting for the treatment of patients with multivessel coronary disease. 18 The aims of the present study were to compare the results of CABG and stented angioplasty in diabetic patients with multivessel coronary disease enrolled in the ARTS trial and to determine the cost of these 2 treatment strategies.…”

mentioning

confidence: 99%

Clinical and economic impact of diabetes mellitus on percutaneous and surgical treatment of multivessel coronary disease patients: insights from the arterial revascularization therapy study (ARTS) trial

Abizaid¹,

Costa²,

Al³

2002

ACC Current Journal Review

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on behalf of the ARTS InvestigatorsBackground-Our aims were to compare coronary artery bypass grafting (CABG) and stenting for the treatment of diabetic patients with multivessel coronary disease enrolled in the Arterial Revascularization Therapy Study (ARTS) trial and to determine the costs of these 2 treatment strategies. Methods and Results-Patients (nϭ1205) were randomly assigned to stent implantation (nϭ600; diabetic, 112) or CABG (nϭ605; diabetic, 96). Costs per patient were calculated as the product of each patient's use of resources and the corresponding unit costs. Baseline characteristics were similar between the groups. At 1 year, diabetic patients treated with stenting had the lowest event-free survival rate (63.4%) because of a higher incidence of repeat revascularization compared with both diabetic patients treated with CABG (84.4%, PϽ0.001) and nondiabetic patients treated with stents (76.2%, Pϭ0.04). Conversely, diabetic and nondiabetic patients experienced similar 1-year event-free survival rates when treated with CABG (84.4% and 88.4%). The total 1-year costs for stenting and CABG in diabetic patients were $12 855 and $16 585 (PϽ0.001) and in the nondiabetic groups, $10 164 for stenting and $13 082 for surgery. Conclusions-Multivessel diabetic patients treated with stenting had a worse 1-year outcome than patients assigned to CABG or nondiabetics treated with stenting. The strategy of stenting was less costly than CABG, however, regardless of diabetic status. (Circulation. 2001;104:533-538.)

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Coronary-Artery Stenting Compared with Balloon Angioplasty for Restenosis After Initial Balloon Angioplasty

Cited by 71 publications

References 0 publications

Safety and efficacy of coronary stent implantation. Acute and six month outcomes of 1,126 consecutive patients treated in 1996 and 1997

Safety and efficacy of coronary stent implantation. Acute and six month outcomes of 1,126 consecutive patients treated in 1996 and 1997

Coronary artery stents: a rapid systematic review and economic evaluation

Clinical and economic impact of diabetes mellitus on percutaneous and surgical treatment of multivessel coronary disease patients: insights from the arterial revascularization therapy study (ARTS) trial

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