Long-term analysis of conventional coronary balloon angioplasty and an initial "stent-like" result - The NHLBI PTCA Registry

Objectives. We examined the influence of an initial "stent-like" result on long-term outcome in patients in the 1985-86 NHLBI PTCA Registry. Background. Stent use in selected patients is associated with improved angiographic and short-term clinical outcome; however, due to potential for in-stent restenosis and high costs of stents, there is interest in a strategy of more optimal dilatation to achieve a "stent like" result without a stent. The long term outcome of patients with a "stent like" percutaneous transluminal coronary angioplasty (PTCA) remains unknown. Methods. Ten year outcome was compared between 225 successfully treated patients with and 1,764 successfully treated patients without an initial "stent-like" result (greater than or equal to 1 lesion dilated to less than or equal to 10% stenosis). The sample had 75% and 80% power, respectively, to detect an absolute difference of 8% in the 10-year rate of death and myocardial infarction (MI) between the two groups. Results. Ten-year rates of death and MI were similar between the stent-like and non-stent-like groups (22.3% vs. 22.2%, 17.6% vs. 17.9%), however, there was less target lesion revascularization in the stent-like group (30.2% vs. 36.8%). In subgroup analysis of patients with multivessel disease, those with a stent like result had less follow-up bypass surgery (25.2% vs. 32.7%), yet more repeat PTCA (53.8% vs. 42.7%). These findings were unaffected by adjustment for differences in baseline characteristics between the two patient groups. Conclusions. Achievement of an initial stent like result via balloon angioplasty alone may not appreciably reduce the longterm risk of death or MI, nor confer equivalent clinical benefit as achieving a stent-like result with a stent. (J Am Coil Cardiol 1998;32:590-5) (C) 1998 by the American College of Cardiology.