Coronary heart disease: stent implantation increased procedural success in occlusion.

Clinical bottom line (level 1b)

  1. Patients with chromic coronary occlusions who were given stent implantation, were more likely to have procedural success than those not given stent implantation (NNT = 4 at 2 years) .
Sievert et al: American Journal of Cardiology 1999; 84: 386-390
Expires March 2003

The study

Unblinded ?concealed randomised trial with intention-to-treat
Setting: general hospital, Germany

110 patients (aged mean 61 years, 72% male) coronary occlusion (TIMI grade 0 flow) for = 1 week, with a vessel diameter of >2.5 mm by visual assessment

Excluded if
  • contraindication to aspirin or ticlopidine
  • acute myocardial infarction
  • saphenous bypass graft
  • severe vessel tortuosity
  • bifurcational lesions



Control Group: (n = 55, 55 analysed): no stent
Experimental Group: (n = 55, 55 analysed): stent implantation, with ticlopidine was given for 2 months after the procedure
All patients underwent successful balloon angioplasty before randomisation. All patients received aspirin 100 mg/day before the study, 300 mg on the day of the procedure and 20,000 U heparin.
100% followed for 2 years
Outcome notes:

  • procedural success : diameter stenosis of <50% without major complication (death, MI, coronary artery bypass surgery or repeat angioplasty)

The evidence

Outcome Time to outcome CEREERRRR
(95% CI)		ARR
(95% CI)		NNT
(95% CI)
procedural success weeks 14
(25.5%)		 29
(52.7%)		 -107%
(-247% to -24.0%)		 -27.3%
(-44.5% to -9.76%)		 4
(2 to 10)

Comments

  1. This CAT is one of several pieces of a larger body of evidence indicating a benefit for stent placement in patients with subacute or chronic total coronary artery occlusion.

Citation

  1. Sievert H, Rohde S, Utech A, et al: Stent or angioplasty after recanalization of chronic coronary occlusions? (The SARECCO) Trial). American Journal of Cardiology 1999; 84: 386-390
Contributor: Clare Wotton, February 2000
Reviewer: Neal S Kleiman

Clinical Question.
Patient chronic coronary occlusion
Intervention or Exposure stent
Comparison angioplasty
Outcome procedural success