Stenting in Chronic Coronary Occlusion (SICCO): a randomized, controlled trial of adding stent implantation after successful angioplasty.

Abstract

OBJECTIVES:

This study investigated whether stenting improves long-term results after recanalization of chronic coronary occlusions.

BACKGROUND:

Restenosis is common after percutaneous transluminal coronary angioplasty (PTCA) of chronic coronary occlusions. Stenting has been suggested as a means of improving results, but its use has not previously been investigated in a randomized trial.

METHODS:

We randomly assigned 119 patients with a satisfactory result after successful recanalization by PTCA of a chronic coronary occlusion to 1) a control (PTCA) group with no other intervention, or 2) a group in which PTCA was followed by implantation of Palmaz-Schatz stents with full anticoagulation. Coronary angiography was performed before randomization, after stenting and at 6-month follow-up.

RESULTS:

Inguinal bleeding was more frequent in the stent group. There were no deaths. One patient with stenting had a myocardial infarction. Subacute occlusion within 2 weeks occurred in four patients in the stent group and in three in the PTCA group. At follow-up, 57% of patients with stenting were free from angina compared with 24% of patients with PTCA only (p < 0.001). Angiographic follow-up data were available in 114 patients. Restenosis (> or = 50% diameter stenosis) developed in 32% of patients with stenting and in 74% of patients with PTCA only (p < 0.001); reocclusion occurred in 12% and 26%, respectively (p = 0.058). Minimal lumen diameter (mean +/- SD) at follow-up was 1.92 +/- 0.95 mm and 1.11 +/- 0.78 mm, respectively (p < 0.001). Target lesion revascularization within 300 days was less frequent in patients with stenting than in patients with PTCA only (22% vs. 42%, p = 0.025).

CONCLUSIONS:

Stent implantation improved long-term angiographic and clinical results after PTCA of chronic coronary occlusions and is thus recommended regardless of the primary PTCA result.

• Authors: P A Sirnes, S Golf, Y Myreng, P Mølstad, H Emanuelsson, P Albertsson, M Brekke, A Mangschau, K Endresen, J Kjekshus
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 28 Issue 6 Pg. 1444-51 (Nov 15 1996) ISSN: 0735-1097 [Print] United States
• PMID: 8917256 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Topics

• Angioplasty, Balloon, Coronary
• Chronic Disease
• Combined Modality Therapy
• Coronary Angiography
• Coronary Disease (diagnostic imaging, prevention & control, therapy)
• Follow-Up Studies
• Hemorrhage (etiology)
• Humans
• Prospective Studies
• Recurrence
• Stents (adverse effects)