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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
[Percutaneous revascularization of multivessel coronary disease using stents - a multicenter, prospective study]
S Baldus1, R Köster, R Küchler
1Abteilung für Kardiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
Insights
Percutaneous coronary angioplasty (PTCA) with stents significantly reduced the need for repeat procedures in multivessel coronary disease (MVD) patients compared to older PTCA methods. While reintervention rates remain higher than with bypass surgery, stenting improved outcomes and decreased bypass surgery necessity.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- Multivessel coronary disease (MVD) patients benefit from both coronary artery bypass grafting (CABG) and percutaneous coronary angioplasty (PTCA).
- The German Angioplasty Bypass Investigation (GABI-I) trial established baseline outcomes for these treatments.
- The GABI-II trial aimed to assess the impact of modern technology, specifically coronary stents, on PTCA outcomes in MVD.
Purpose of the Study:
- To evaluate the effectiveness of contemporary percutaneous coronary angioplasty (PTCA) with stenting in patients with multivessel coronary disease (MVD).
- To compare the outcomes of PTCA with stenting in the GABI-II trial against historical data from the GABI-I trial, particularly the PTCA arm.
Main Methods:
- Prospective enrollment of 136 patients with MVD between 1996 and 1997, following GABI-I criteria.
- Patients undergoing PTCA with stenting were compared to historical controls from the GABI-I trial (randomized 1986-1991).
- Assessment of clinical endpoints, including symptom severity (CCS class), need for emergency/urgent bypass surgery, and reintervention rates (repeat PTCA or bypass surgery) at 12 months.
Main Results:
- Sixty-three percent of lesions in GABI-II were treated with stents, with an average of 2.1 vessels treated per patient.
- Significantly fewer patients in GABI-II had Canadian Cardiovascular Society (CCS) class III or IV symptoms at 12 months (1.5% vs. 8% in GABI-I PTCA arm, p<0.01).
- The need for subsequent bypass surgery (8% vs. 21%, p<0.001) and repeat PTCA (20% vs. 23%) was reduced in GABI-II compared to GABI-I PTCA, leading to a higher rate of patients without reinterventions (72% vs. 56%, p<0.01).
Conclusions:
- Percutaneous coronary angioplasty (PTCA) in multivessel coronary disease (MVD) patients, even with stenting, is associated with a higher reintervention rate compared to coronary artery bypass grafting (CABG).
- However, PTCA combined with coronary stents significantly reduces the need for subsequent revascularization, particularly bypass surgery, compared to angioplasty performed a decade prior.
- Stent technology has substantially improved the outcomes of PTCA for MVD patients, decreasing the need for further interventions.
Background And Objective:
Symptomatic patients with multivessel coronary disease (MVD) benefit from both coronary artery bypass grafting (CABG) and percutaneous coronary angioplasty (PTCA). The >>German Angioplasty Bypass Investigation<< (GABI-I) trial randomized patients to one of these treatment strategies between 1986 and 1991. In order to evaluate the impact of current technology, in particular coronary stents, the GABI-II trial was initiated, which in 1996 and 1997 prospectively enrolled patients according to the initial GABI-I criteria.
Patients And Methods:
Into the study 136 consecutive patients (108 men, 28 women; 63 +/- 12 years) were included. Patients from GABI-I served as controls.
Results:
A mean of 2.1 +/- 0.5 vessels were treated per patient (vs. 1.9 +/- 0.5 vessels in the PTCA arm of GABI-I) and 63 % of the lesions were covered with stents. With respect to the primary endpoint less patients remained with a CCS class III or IV in GABI-II after 12 months (1,5 % vs. 8 % in the PTCA arm of GABI-I, p<0,01). No patient required emergency or urgent bypass operation in GABI-II (vs. 9 % in GABI-I, p < 0.01). After 12 months, 8 % of the patients were sent for bypass surgery (CABG) vs. 21 % in GABI-I (p < 0.001), and 20 % (vs. 23 % in GABI-I) of the patients underwent Re-PTCA. The percentage of patients without reinterventions was 72 % vs. 56 % in GABI-I (p < 0.01), but remained lower compared to patients randomized to CABG in GABI-I (94 %, p < 0.001).
Conclusion:
PTCA in patients with MVD is still associated with a higher reintervention rate as compared with CABG. However, in contrast to angioplasty a decade ago, PTCA in conjunction with stents significantly lowered the need for subsequent revascularization, which was mainly driven by the reduced necessity for bypass surgery.
