Final Results of the Balloon vs Optimal Atherectomy Trial (BOAT)

Baim, Donald S.; Cutlip, Donald E.; Sharma, Samin K.; Ho, Kalon K.L.; Fortuna, Richard; Schreiber, Theodore; Feldman, Robert L.; Shani, Jacob; Senerchia, Cynthia; Zhang, Yan; Lansky, Alexandra J.; Popma, Jeffrey J.; Kuntz, Richard E.

doi:10.1161/01.cir.97.4.322

Cited by 209 publications

(94 citation statements)

References 24 publications

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“…Procedural success was obtained in 88.9% of cases, as compared with 92% in the Balloon versus Optimal Atherectomy Trial (BOAT). 25 The MLD after the procedure was 2.81 mm in this trial and 2.82 mm in BOAT; in the subgroup of patients with "optimal atherectomy," the MLD after the procedure was 3.09 mm in this trial compared with 3.16 mm in the Optimal Atherectomy Restenosis Study (OARS). 26 The late loss (0.81 mm) in EUROCARE was substantially less than that in both BOAT (0.96 mm) and OARS (1.18 mm), so the restenosis rate in EUROCARE is also lower (23.6%) than that in BOAT (31.4%) and OARS (28.9%).…”

Section: Comparison Of Atherectomy Results With Other Trialsmentioning

confidence: 65%

Carvedilol for Prevention of Restenosis After Directional Coronary Atherectomy

et al. 2000

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on behalf of the EUROCARE study groupBackground-In addition to its known properties as a competitive, nonselective ␤ and ␣-1 receptor blocker, carvedilol directly inhibits vascular myocyte migration and proliferation and exerts antioxidant effects that are considerably greater than those of vitamin E or probucol. This provides the basis for an evaluation of carvedilol for the prevention of coronary restenosis. Methods and Results-In a prospective, double-blind, randomized, placebo-controlled trial, 25 mg of carvedilol was given twice daily, starting 24 hours before scheduled directional coronary atherectomy and continuing for 5 months after a successful procedure. The primary end point was the minimal luminal diameter as determined during follow-up angiography 26Ϯ2 weeks after the procedure. Of 406 randomized patients, 377 underwent attempted atherectomy, and in 324 (88.9%), a Յ50% diameter stenosis was achieved without the use of a stent. Evaluable follow-up angiography was available in 292 eligible patients (90%). No differences in minimal luminal diameter (1.99Ϯ0.73 mm versus 2.00Ϯ0.74 mm), angiographic restenosis rate (23.4% versus 23.9%), target lesion revascularization (16.2 versus 14.5), or event-free survival (79.2% versus 79.7%) between the placebo and carvedilol groups were observed at 7 months. Conclusions-The maximum recommended daily dose of the antioxidant and ␤-blocker carvedilol failed to reduce restenosis after successful atherectomy. These findings are in contrast to those of the Multivitamins and Probucol Trial, which raises doubts regarding the validity of the interpretation that restenosis reduction by probucol was via antioxidant effects. The relationship between antioxidant agents and restenosis remains to be elucidated. (Circulation.

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Section: Comparison Of Atherectomy Results With Other Trialsmentioning

confidence: 65%

Carvedilol for Prevention of Restenosis After Directional Coronary Atherectomy

et al. 2000

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“…[11][12][13] Because patients with renal failure have a higher incidence of complex coronary lesion morphology, which is less amenable to conventional balloon angioplasty, 8 these new devices may offer hope to this population. In our study, percuta- neous interventional methods changed considerably during the period of observation.…”

Section: Discussionmentioning

confidence: 99%

“…8 Over the last decade, new lesion-specific coronary devices, such as coronary stents and a variety of debulking techniques, have improved the outcome of PCI in complex lesions. [9][10][11][12][13] Therefore, the present study was designed to determine the immediate and long-term outcomes of patients with varying degrees of renal failure in the current new device era.…”

mentioning

confidence: 99%

Are Patients With Renal Failure Good Candidates for Percutaneous Coronary Revascularization in the New Device Era?

et al. 2000

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Background-Patients with end-stage renal disease undergoing conventional balloon angioplasty have reduced procedural success and increased complication rates. This study was designed to determine the immediate and long-term outcomes of patients with varying degrees of renal failure undergoing percutaneous coronary intervention in the current device era. Methods and Results-We compared the immediate and long-term outcomes of 362 renal failure patients (creatinine Ͼ1.5 mg/dL) with those of 2972 patients with normal renal function who underwent percutaneous coronary intervention between 1994 and 1997. Patients with renal failure were older and had more associated comorbidities. They had reduced procedural success (89.5% versus 92.9%, Pϭ0.007) and greater in-hospital combined major event (death, Q-wave myocardial infarction, emergent CABG; 10.8% versus 1.8%; PϽ0.0001) rates. Renal failure was an independent predictor of major adverse cardiac events (MACEs) (OR, 3.41; 95% CI, 1.84 to 6.22; PϽ0.00001). Logistic regression analysis identified shock, peripheral vascular disease, balloon angioplasty strategy, and unstable angina as independent predictors of in-hospital MACEs in the renal group. Compared with 362 age-and sex-matched patients selected from the control group, patients with renal failure had a lower survival rate (27.7% versus 6.1%, PϽ0.0001) and a greater MACE rate (51% versus 33%, PϽ0.001) at long-term follow-up. Cox regression analysis identified age and PTCA strategy as independent predictors of long-term MACEs in the renal group. Finally, within the renal failure population, the dialysis and nondialysis patients experienced remarkably similar immediate and long-term outcomes. Conclusions-Although patients with renal failure can be treated with a high procedural success rate in the new device era, they have an increased rate of major events both in hospital and at long-term follow-up. Nevertheless, utilization of stenting and debulking techniques improves immediate and long-term outcomes. (Circulation. 2000;102:2966-2972.)

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“…The concept of optimal atherectomy was formally tested in the Balloon versus Optimal Atherectomy Trial (BOAT), in which 1000 patients with new lesions in native coronary arteries were randomly assigned to undergo either DCA with aggressive tissue removal (target residual stenosis Ͻ20%) or conventional PTCA. 6 Angiographic success was slightly better with DCA, with a superior residual stenosis (15% for DCA versus 28% for PTCA). Importantly, these results were achieved without an increase in death, Q-wave MI, or emergency surgery: 2.8% versus 3.3%.…”

Section: Dca To Reduce Restenosis: a Tortured Seasonmentioning

confidence: 89%