Coronary heart disease: stent implantation decreased restenosis and reocclusion in chronic occlusion.

Clinical bottom line (level 2b)

  1. Patients with chronic total occlusion who were given stent implantation, were less likely to have restenosis than those not given stenting (NNT = 3 at 6 months) .
  2. Patients given stenting were less likely to have reocclusion than those given no stenting (NNT = 5 at 6 months) .
Hoher et al: Journal of the American College of Cardiology 1999; 34 (3): 722-729
Expires March 2003

The study

Unblinded ?concealed randomised trial with intention-to-treat
Setting: two centres, Germany

85 patients (aged range 34 to 78 years; median 63, 69% male) chronic total coronary occlusion, with the causative event of the occlusion occurring at least 28 days earlier, with proven ischaemia in the supplied area

Excluded if
  • contraindications for anticoagulation with phenprocoumon, ticlopidine or acetylsalicylic acid
  • renal failure
  • recent cerebrovascular event


Note:
  • There were significantly more men in the no stent group.


Control Group: (n = 43, 43 analysed): no stent
Experimental Group: (n = 42, 42 analysed): Wiktor stent implantation, with phenprocoumon or ticlopidine 2x250 mg/day and aspirin 300 mg/day for three months
All patients underwent successful balloon angioplasty. All patients had 500 mg aspirin orally or iv and 10,000 U bolus of heparin, before the procedure, and 100 mg/day aspirin throughout the study.
79% followed for 6 months
Outcome notes:
  • restenosis : >50% stenosis on follow-up angiogram

The evidence

Outcome Time to outcome CEREERRRR
(95% CI)		ARR
(95% CI)		NNT
(95% CI)
restenosis 6 months 27
(62.8%)		 14
(33.3%)		 47.0%
(14.0% to 67.0%)		 29.5%
(9.16% to 49.8%)		 3
(2 to 11)
reocclusion 6 months 10
(23.3%)		 1
(2.38%)		 90.0%
(23.0% to 99.0%)		 20.9%
(7.43% to 34.3%)		 5
(3 to 13)

Comments

  1. A small sample size, the methodology of quantitative coronary angiography, a larger reference diameter in the stent arm group, no data regarding target lesion length, and a low angiographic follow-up rate all make this a less-than-perfect study.
  2. Seven patients crossed over into the stenting group.

Citation

  1. Hoher M, Wohrle J, Grebe OC, et al: A randomized trial of elective stenting after balloon recanalization of chronic total occlusions. Journal of the American College of Cardiology 1999; 34 (3): 722-729
Contributor: Clare Wotton and Bob Phillips, February 2000
Reviewer: Etsuo Tsuchikane

Clinical Question.
Patient chronic coronary occlusion
Intervention or Exposure stent implantation
Comparison no stenting
Outcome restenosis and reocclusion