A clinical trial comparing primary stenting of the infarct-related artery with optimal primary angioplasty for acute myocardial infarction: results from the Florence Randomized Elective Stenting in Acute Coronary Occlusions (FRESCO) trial

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J Am Coll Cardiol, 1998; 31:1234-1239
© 1998 by the American College of Cardiology Foundation

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A clinical trial comparing primary stenting of the infarct-related artery with optimal primary angioplasty for acute myocardial infarction: results from the Florence Randomized Elective Stenting in Acute Coronary Occlusions (FRESCO) trial

D Antoniucci, GM Santoro, L Bolognese, R Valenti, M Trapani, and PF Fazzini

Division of Cardiology, Careggi Hospital, Florence, Italy. carddept@tin.it

OBJECTIVES: This study sought to compare stenting of the primary infarct-related artery (IRA) with optimal primary percutaneous transluminal coronary angioplasty (PTCA) with respect to clinical and angiographic outcomes of patients with an acute myocardial infarction. BACKGROUND: Early and late restenosis or reocclusion of the IRA after successful primary PTCA significantly contributes to increased patient morbidity and mortality. Coronary stenting results in a lower rate of angiographic and clinical restenosis than standard PTCA in patients with angina and with previously untreated, noncomplex lesions. METHODS: After successful primary PTCA, 150 patients were randomly assigned to elective stenting or no further intervention. The primary end point of the trial was a composite end point, defined as death, reinfarction or repeat target vessel revascularization as a consequence of recurrent ischemia within 6 months of randomization. The secondary end point was angiographic evidence of restenosis or reocclusion at 6 months after randomization. RESULTS: Stenting of the IRA was successful in all patients randomized to stent treatment. At 6 months, the incidence of the primary end point was 9% in the stent group and 28% in the PTCA group (p=0.003); the incidence of restenosis or reocclusion was 17% in the stent group and 43% in the PTCA group (p=0.001). CONCLUSIONS: Primary stenting of the IRA, compared with optimal primary angioplasty, results in a lower rate of major adverse events related to recurrent ischemia and a lower rate of angiographically detected restenosis or reocclusion of the IRA.

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				G. De Luca, H. Suryapranata, R. Grimaldi, and M. Chiariello Coronary stenting and abciximab in primary angioplasty for ST-segment-elevation myocardial infarction QJM, September 1, 2005; 98(9): 633 - 641. [Abstract] [Full Text] [PDF]

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				D. A. Cox and G. W. Stone Composite confusion: Reply J. Am. Coll. Cardiol., May 19, 2004; 43(10): 1927 - 1927. [Full Text] [PDF]

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				D. A. Morrison Counterintuitive contributionsto the care of myocardialinfarction and theneed for randomized trials J. Am. Coll. Cardiol., September 17, 2003; 42(6): 978 - 980. [Full Text] [PDF]

				A. J. Karavidas, A. D. Vrachatis, M. A. Alpert, D. J. Nikas, D. J. Achtypis, M. G. Foukarakis, E. P. Matsakus, C. S. Thedocharis, and A. A. Zacharoulis Primary Stenting Produces Earlier and More Efficient Myocardial Reperfusion than Primary PTCA Alone in Patients with Acute ST Segment Elevation MI Angiology, March 1, 2003; 54(2): 195 - 203. [Abstract] [PDF]

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				G. W. Stone, C. L. Grines, D. A. Cox, E. Garcia, J. E. Tcheng, J. J. Griffin, G. Guagliumi, T. Stuckey, M. Turco, J. D. Carroll, et al. Comparison of Angioplasty with Stenting, with or without Abciximab, in Acute Myocardial Infarction N. Engl. J. Med., March 28, 2002; 346(13): 957 - 966. [Abstract] [Full Text] [PDF]

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