Myocardial infarction: stenting decreased restenosis.

Clinical bottom line (level 1b)

  1. Patients who had recently had percutaneous transluminal coronary angioplasty who were stented were less likely to have restenosis, than those not stented (NNT = 2 at 6 months)
  2. Patients who were stented had slightly better chances of not having reocclusion than those not stented. (NNT = 7 at 6 months)
Sirnes et al: Journal of the American College of Cardiology 1996; 28: 1444-1451
Expires March 2003

The study

Unblinded ?concealed randomised trial with intention-to-treat
Setting: 4 centres, Scandinavia

117 patients (aged mean 58 years, 82% male) undergone percutaneous transluminal coronary angioplasty of an occluded native coronary artery in the study period

Excluded if
  • = 18 years old
  • occlusions <2 weeks old
  • did not tolerate anticoagulation regimen
  • participation in another clinical trial or unlikely to return for follow-up
  • lesion reference diameter <2.5 mm
  • indication for stenting of lesion
  • previously dilated segments of lesion
  • lesions treated with devices other than percutaneous transluminal coronary angioplasty
  • lesions with complex anatomy making successful stent deployment unlikely
  • lesions with poor distal run off
  • angiographically visible thrombus adjacent to the occlusion site



Control Group: (n = 59, 57 analysed): percutaneous transluminal coronary angioplasty alone
Experimental Group: (n = 58, 58 analysed): Coronary stenting after percutaneous transluminal coronary angioplasty. One or more stents were implanted with the aim to stent the entire lesion. Dextran (1,000 ml, 50 ml/h) infusion was given as soon as possible after randomisation. Dipyridamole (75 mg three times daily) and warfarin at a dosage adjusted as necessary were also given for the first three months.
All patients were pretreated with aspirin (75 to 160 mg daily)and a bolus injection of heparin (10,000 to 15,000 IU) was given before angioplasty.
100% followed for 6 months
Outcome notes:

  • restenosis : =50% diameter stenosis

The evidence

Outcome Time to outcome CEREERRRR
(95% CI)		ARR
(95% CI)		NNT
(95% CI)
restenosis 6 months 42
(73.7%)		 18
(31.6%)		 57.0%
(35.0% to 72.0%)		 42.1%
(25.5% to 58.7%)		 2
(2 to 4)
reocclusion 6 months 15
(26.3%)		 7
(12.3%)		 53.0%
(-6.00% to 79.0%)		 14.0%
(-0.22% to 28.3%)		 7
(NNT = 4 to infinity;
NNH = 449 to infinity)

Citation

  1. Sirnes PA, Golf S, Myreng Y, et al: Stenting in chronic coronary occlusion (SICCO): A randomized, controlled trial of adding stent implantation after successful angioplasty. Journal of the American College of Cardiology 1996; 28: 1444-1451
Contributor: Clare Wotton and Musab Hayatli, December 1999
Reviewer:

Clinical Question.
Patient recent recanalisation of coronary occlusions
Intervention or Exposure stenting
Comparison no stenting
Outcome restenosis