Angioplasty: routine stenting of single vessels reduces cardiac events and readmission to hospital.

Clinical bottom line (level 1b)

  1. Patients with single-vessel heart disease undergoing angioplasty who received routine stent insertion compared with provisional stenting were less likely to die, have a myocardial infarction or require repeat revascularisation (NNT = 11 at 6 months) .
  2. Patients undergoing routine stent insertion were less likely to be readmitted to hospital (NNT = 9 at 6 months) .
Weaver et al: Lancet 2000; 355 : 2199-2203
Expires November 2003

The study

Single-blinded concealed randomised trial without intention-to-treat
Setting: 44 cardiology units with experience in angioplasty and stent insertionitals, USA and Canada

479 patients (aged median 60, 73% male) with stable or unstable angina , a positive functional test for ischaemia or who were undergoing angioplasty after a recent myocardial infarction (> 24 hours). Considered eligible if angiogram demonstrated a single lesion with at least 70% stenosis, no more than 20 mm in length and a coronary artery diameter of at least 3.0 mm, treatable by balloon angioplasty or stent.

Excluded if
  • allergy or contraindication to aspirin
  • concurrent illnesss believed to limit life expectancy to less than 1 year
  • more than 45 degree anglulation of lesion
  • ostial stenosis
  • moderate to severe calcificattion
  • aged < 21 or > 81
  • known requirement for treatment of more than one coronary vessel
  • more than one previous intervention at the target-vessel site

Control Group: (n = 230, 229 analysed): routine stent insertion. Patients received 325 mg aspirin daily. Ticlopidine was recommended for 4 weeks post-procedure.
Experimental Group: (n = 249, 248 analysed): initial balloon angioplasty and provisional stenting
Patients could receive heparin, abciximab and have multiple stents inserted.
99.5% followed for 6 months
Outcome notes:
  • cardiac event : myocardial infarction, target vessel revascularisation, cardiac surgery, death

The evidence

Outcome Time to outcome CER EER RRR
(95% CI)		 ARR
(95% CI)		 NNH
(95% CI)
cardiac event 6 months 14
(6.11%)		 37
(14.9%)		 -144%
(-339% to -36%)		 -8.81%
(-14.2% to -3.39%)		 11
(7 to 29)
readmission to hospital 6 months 12
(5.24%)		 32
(12.9%)		 -150%
(-323% to -84%)		 -11.1%
(-17.0% to -5.21%)		 9
(6 to 19)

Comments

  1. Patients were stratified by site.
  2. 99% of patients in the stent group had a stent inserted compared with 37% in the provisional stenting group.

Citation

  1. Weaver WD, Reisman MA, Griffin JJ, et al: optimum percutaneous transluminal coronary angioplasty compared with routine stent strategy trial (OPUS-1): a randomised trial. Lancet 2000; 355 : 2199-2203
Search Terms: from other articles noted in ACP Journal Club
Contributor: Chris Ball, November 2001
Reviewer:

Clinical Question.
Patient single vessel coronary artery disease
Intervention or Exposure angioplasty with provisional stent insertion
Comparison routine stent insertion
Outcome