Primary Stenting Versus Balloon Angioplasty in Occluded Coronary Arteries

Buller, Christopher E.; Džavík, Vladimir; Carere, Ronald G.; Mancini, G.B. John; Barbeau, Gérald; Lazzam, Charles; Anderson, Todd J.; Knudtson, Merril L.; Marquis, Jean-François; Suzuki, Takahiko; Cohen, Éric A.; Fox, Rebecca; Teo, Koon K.

doi:10.1161/01.cir.100.3.236

Cited by 235 publications

(119 citation statements)

References 26 publications

Supporting

Mentioning

107

Contrasting

Unclassified

Order By: Relevance

“…4,6,7 In spite of the efficacy of stenting of coronary occlusions, 15,16 studies using routine stenting and showing excellent longterm patency have continued to show mixed or inconclusive results. 3,5 The postulated mechanisms underpinning the potential benefits of late opening of the IRA center on improvement of LV function and reduction of LV remodeling.…”

Section: Discussionmentioning

confidence: 99%

Randomized Trial of Percutaneous Coronary Intervention for Subacute Infarct-Related Coronary Artery Occlusion to Achieve Long-Term Patency and Improve Ventricular Function

et al. 2006

Self Cite

View full text Add to dashboard Cite

Background-In the present study, we sought to determine whether opening a persistently occluded infarct-related artery (IRA) by percutaneous coronary intervention (PCI) in patients beyond the acute phase of myocardial infarction (MI) improves patency and indices of left ventricular (LV) size and function. Methods and Results-Between May 2000 and July 2005, 381 patients with an occluded native IRA 3 to 28 days after MI (median 10 days) were randomized to PCI with stenting (PCI) or optimal medical therapy alone. Repeat coronary and LV angiography was performed 1 year after randomization (nϭ332, 87%). Coprimary end points were IRA patency and change in LV ejection fraction. Secondary end points included change in LV end-systolic and end-diastolic volume indices and wall motion. PCI was successful in 92%. At 1 year, 83% of PCI versus 25% of medical therapy-only patients had a patent IRA (PϽ0.001). LV ejection fraction increased significantly (PϽ0.001) in both groups, with no between-group difference: PCI 4.2Ϯ8.9 (nϭ150) versus medical therapy 3.5Ϯ8.2 (nϭ136; Pϭ0.47). Median change (interquartile range) in LV end-systolic volume index was Ϫ0.5 (Ϫ9.3 to 5.0) versus 1.0 (Ϫ5.7 to 7.3) mL/m 2 (Pϭ0.10), whereas median change (interquartile range) in LV end-diastolic volume index was 3.2 (Ϫ8.2 to 13.3) versus 5.3 (Ϫ4.6 to 23.2) mL/m 2 (Pϭ0.07) in the PCI (nϭ86) and medical therapy-only (nϭ76) groups, respectively. Conclusions-PCI with stenting of a persistently occluded IRA in the subacute phase after MI effectively maintains long-term patency but has no effect on LV ejection fraction. On the basis of these findings and the lack of clinical benefit in the main Occluded Artery Trial, routine PCI is not recommended for stable patients with a persistently occluded IRA after MI. (Circulation. 2006;114:2449-2457.)

show abstract

Section: Discussionmentioning

confidence: 99%

Randomized Trial of Percutaneous Coronary Intervention for Subacute Infarct-Related Coronary Artery Occlusion to Achieve Long-Term Patency and Improve Ventricular Function

et al. 2006

Self Cite

View full text Add to dashboard Cite

show abstract

“…However, in TOSCA 85 (a trial of patients with occluded arteries), it is clear that there is a persistent number of patients suffering serious symptoms arising from disease in other than the initially targeted vessels (around 10% of PTCA patients per year of follow-up requiring revascularisation) which is not altered by the trial intervention. The 12-month follow-up results from STRESS I 222 show that although TLRs are reduced by 32% as a result of stenting, all revascularisations fell by only 17%, indicating that interventions which benefit disease in specific vessels do not lead to equivalent changes in the number of patients needing repeat treatment (i.e.…”

Section: Clinical Outcomesmentioning

confidence: 99%

“…These included 23 studies comparing stenting with PTCA in patients with non-specific CAD, 11 comparing stents with PTCA following AMI, 59-69 eight 70-77 including patients with small coronary arteries and eight including patients whose vessels had chronic total occlusion (CTO). [78][79][80][81][82][83][84][85] Thirty-nine studies were assessed from reports published in peer-reviewed journals. The remainder were abstracts of conference proceedings.…”

Section: Ptca: Included Studies Introductionmentioning

confidence: 99%

Coronary artery stents: a rapid systematic review and economic evaluation

Hill¹,

Bagust²,

Bakhai³

et al. 2004

Health Technol Assess

144

View full text Add to dashboard Cite

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...

show abstract

“…The results have improved because of recent advances in technology and increased operator experience. [1][2][3][4][5][6][7] Recent studies show that successful PCI of a CTO is associated with improved survival; 8,9 however, the total fluoroscopic time (TFT) tends to be long in this procedure compared with PCI for non-CTO. 10 The patient's entrance skin doses (ESD) are higher 10,11 and severe skin injury can occur, so the physician must estimate the ESD in order to prevent radiation skin injuries during the procedure.…”

mentioning

confidence: 99%

Factors Affecting the Patient's Skin Dose During Percutaneous Coronary Intervention for Chronic Total Occlusion

Suzuki

Furui

Isshiki

et al. 2007

Circ J

View full text Add to dashboard Cite

hronic total occlusion (CTO) has been considered as a relative contraindication for percutaneous coronary intervention (PCI), because of its low success rate and high restenosis rate. The results have improved because of recent advances in technology and increased operator experience. [1][2][3][4][5][6][7] Recent studies show that successful PCI of a CTO is associated with improved survival; 8,9 however, the total fluoroscopic time (TFT) tends to be long in this procedure compared with PCI for non-CTO. 10 The patient's entrance skin doses (ESD) are higher 10,11 and severe skin injury can occur, so the physician must estimate the ESD in order to prevent radiation skin injuries during the procedure. However, there is inadequate assessment of this issue in the literature.The purpose of this research was to measure the patient's ESD during PCI for CTO, analyze the factors that affect it and assess the methods used to estimate the maximum ESD from both patient and angiographic data. Circulation Journal Vol.71, February 2007 Methods Patient PopulationThis study focused on 23 consecutive patients (6 women, 17 men) who underwent PCI for CTO with evaluation of the ESDs from July 2004 to September 2005. The average patient age was 68.9±7.7 years (range: 53.6-82.2). AngiographyAdvantX LC and AdvantX LC/LP equipment (General Electric Medical Systems, Milwaukee, WI, USA) were used for angiography. The image intensifiers of both units were renewed in April 2004. Each unit had an undercouch tube and an overcouch image intensifier with 3 fields of view: 9, 6, and 4.5 inches in diameter. A 6-inch field of view was used mainly in this assessment. In both units, the total filtration was equivalent to 2.7 mm aluminum. Procedures were performed using pulse-mode fluoroscopy. The period of use was 9 years for each unit. PCI and ESD MeasurementThe patient wore a jacket with 52 radiosensitive indicators (Nichiyu Giken Kogyo Co, Ltd, Saitama, Japan) placed on the back. Radiosensitive indicators use a functional dye in which the color changes from translucent to red with Xray absorption. Indicators were arranged in 6 rows (from top to bottom: 1, 2, 3, 4, 5, and 6) and 8 columns (from left to right: A, B, C, D, E, F, G, and H) at intervals of 7 cm. An additional 4 indicators were placed in the 7th row (C7, D7, E7, and F7), except for 2 patients. Four experienced cardiologists performed the procedures using standard tech- Background The aim of this study was to measure the patient entrance skin dose (ESD) during percutaneous coronary intervention (PCI) for chronic total occlusion (CTO), and assess the factors that affect it. Methods and ResultsRadiosensitive indicators were used to measure ESDs during 23 procedures. Multiple regression analysis identified the strength of the linear relationship of the dependent variable (the natural logarithm of the maximum ESD) with the set of multiple independent variables (the natural logarithm of both the patient and angiographic data). The methods for estimating the maximum ESD and the estimated ESDs w...

show abstract

Primary Stenting Versus Balloon Angioplasty in Occluded Coronary Arteries

Cited by 235 publications

References 26 publications

Randomized Trial of Percutaneous Coronary Intervention for Subacute Infarct-Related Coronary Artery Occlusion to Achieve Long-Term Patency and Improve Ventricular Function

Randomized Trial of Percutaneous Coronary Intervention for Subacute Infarct-Related Coronary Artery Occlusion to Achieve Long-Term Patency and Improve Ventricular Function

Coronary artery stents: a rapid systematic review and economic evaluation

Factors Affecting the Patient's Skin Dose During Percutaneous Coronary Intervention for Chronic Total Occlusion

Contact Info

Product

Resources

About